2009;83:83C9. was placed on shared decision-making, especially regarding second-line treatment. strong class=”kwd-title” Keywords: Immune thrombocytopenia, Recommendation, Management INTRODUCTION Purpose of these guidelines These guidelines aimed to provide helpful recommendations for managing adult and pediatric patients with immune thrombocytopenic purpura (ITP). In addition, these guidelines aim to provide clinical support for the decision-making process regarding different treatment courses. Clinical situation and impact of ITP ITP is an acquired autoimmune disorder characterized by low platelet count resulting from platelet destruction and impaired production. The incidence of ITP in Western countries is usually 2C5 per 100,000 person-years [1-5]. In national studies using the Korea Dihexa Health Insurance Research and Assessment (HIRA) database, the incidence rate of ITP for all those ages is usually 5.3 per 100,000 person-years, while it is 13.39 and 18.1 per 100,000 person-years for children aged 18 years [6-8]. ITP can be an isolated main event or secondary to other clinical conditions. ITP is usually a heterogeneous disorder with variable clinical symptoms and indicators and remains a diagnosis of exclusion of other causes of thrombocytopenia [9]. The clinical course of ITP may also vary depending on whether it is main ITP (not associated with other conditions), occurring in the setting of autoimmune cytopenia (Evans syndrome), a manifestation of main immunodeficiency, or is usually associated with autoimmune or infectious causes (secondary ITP). In secondary ITP, treatment is usually often directed towards managing underlying causes. Bleeding episodes are often unpredictable, and patients with ITP, even in severe thrombocytopenia, may not have bleeding, except bruising and petechiae [10-12]. However, severe bleeding may occur [11-13]. Severe bleeding was reported in 9.5% [95% confidence interval (CI), 4.1C17.1] of adults [11]. Adults with ITP have a 1.3C2.2-fold Dihexa higher mortality rate than the general population due to cardiovascular events, infectious diseases, and bleeding episodes [14]. In addition, ITP has a significant impact on health-related quality of life (HRQoL) [15, 16]. Whether a patient can be observed without treatment or requires further treatment is usually complex and varies based on comorbidities, medications, and age, all of which affect the risk of bleeding [17, 18]. In addition, management methods may vary according to the duration of the disease, accessibility to care, quality of life implications, and preferences of the patient and clinicians. Considering the inter-patient variability in the pathophysiology of immune dysregulation and the lack of effective predictors of treatment response, the choice of appropriate therapy may vary significantly among physicians when the treatment has been made the decision [19]. For the 2022 update, an expert panel reviewed the evidence published since the 2017 Korean recommendation [20]. In these guidelines, the expert panel recommended valuable principles for managing adult and pediatric patients with ITP based on evidence and expert opinions. RECOMMENDATIONS Management of adult patients with newly diagnosed ITP Corticosteroids versus observation Recommendation 1 In adult patients with newly diagnosed ITP and a platelet count 20109/L without symptoms or with minor mucocutaneous bleeding, we recommend corticosteroids rather than observation. To choose corticosteroid versus observation, physicians should consider the level of platelet count, additional comorbidities, use of anticoagulant or antiplatelet brokers, need for subsequent procedures, and patient age. The benefits cannot be estimated from the data because Dihexa of the lack of direct comparison results [21-27]. The response rate of the platelet count number at 7 days was 55.8% with corticosteroids; however, the Dihexa overall remission rate was relatively low (30.2%) [21]. The harms and burdens could not be precisely estimated from the data because of the lack of direct comparison results. Undesirable adverse effects of observation exist in this setting, considering that thrombocytopenia is Dihexa usually a surrogate for future bleeding events and treatment failure in adult patients. Bleeding episodes (3.3%) and mortality (5.7%) were only reported in the corticosteroid-treated group [26]. Recommendation 2 In adult patients with newly diagnosed ITP and a platelet count 20109/L without symptoms or minor mucocutaneous bleeding, we recommend observation rather than corticosteroids. For patients with a platelet count at the lower end of this threshold, those with additional comorbidities, anticoagulant or antiplatelet brokers, or need to follow the CAB39L procedures. Corticosteroid treatment may be appropriate for elderly patients (aged 60 yr). The benefit cannot be precisely estimated from the data because of the lack of direct comparison results. However, major bleeding episodes were not different and low in both arms (corticosteroids vs. observation: 0.9% vs. 0%) [28-32]. Based on indirect evidence, the side effects of corticosteroids are not trivial; therefore, the undesirable adverse effects of corticosteroids are moderate. Duration and type of corticosteroids Recommendation 3 In adult patients with newly diagnosed ITP, we recommend a short course (6 wk) of prednisone rather than a prolonged course ( 6 wk, including.