This prospective, single-arm, multicenter, exploratory study will enroll 38 adults patients with newly diagnosed primary immune thrombocytopenia (ITP). Patients will receive standard-dose corticosteroids plus a thrombopoietin receptor agonist (TPO-RA) as initial therapy During the core treatment phase (Weeks 1-12). Corticosteroids will be tapered and discontinued within 8 weeks, whereas TPO-RA treatment will continue for 12 weeks. For patients with treatment failure( defined as platelet count \< 30 × 10\^9/L or less than 2-fold increase of baseline platelet count or bleeding) ,a sequential multitarget combination strategy will be explored in subsequent treatment phases. Specifically, patients with treatment failure after 2 weeks of initial therapy (Weeks 3-12), will receive the ongoing TPO-RA in combination with either rituximab or an anti-CD38 monoclonal antibody（mAb） as sequential combination therapy.
During the core treatment follow-up phase (24 weeks), patients with treatment failure will enter the exploratory treatment phase (Weeks 13-36) .
Patients who received multi-target drug therapy during the core treatment period will switch to an alternative TPO-RA with cross-administered rituximab and anti-CD38 mAb, while those who did not will receive sequential rituximab or anti-CD38 mAb.
Finally, patients will enter the safety follow up period (4 weeks, weeks 37-40).
Age ≥18 years.
Confirmed newly diagnosed primary ITP with a platelet count <30 × 10^9/L.
No prior ITP-related treatment before enrollment, except for standard-dose corticosteroids and/or IVIG for ≤5 days.
Able to understand the study and provide signed informed consent.-
Use of corticosteroids or immunosuppressants for a non-ITP condition within 3 months.
Contraindication to corticosteroid therapy.
Arterial or venous thromboembolic event within 3 months.
Pregnant or breastfeeding women.
Sequential
standard-dose methylprednisolone/prednisone.
DrugMethylprednisolone 0.8-1mg/kg/day administered intravenously or orally; or prednisone 1 mg/kg/day, up to a maximum dose of 80 mg/day
thrombopoietin receptor agonist(TPO-RA), including but not limited to hetrombopag or eltrombopag.
DrugDosing will follow the recommended dose in the prescribing information; in severe ITP, the initial dose will be selected according to BAT (best available therapy) principles.
rituximab.
DrugAdministered as 375 mg/m² by intravenous infusion for a single dose, or 100 mg by intravenous infusion once weekly for a total of 4 doses.
Daratumumab
DrugAdministered at 16 mg/kg by intravenous infusion once weekly for a total of 4-8 doses.
sustained response rate
Defined as the proportion of patients who achieve a platelet count ≥30×10\^9/L at least 6 out of 12 scheduled visits during the 24 weeks following the core treatment period (weeks 13-36), in the absence of rescue therapy
time to response
The time from treatment initiation to achieve a complete response(platelet count ≥100 × 109/L and absence of bleeding) or a partial response(platelet count ≥30 × 10\^9/L and at least 2-fold increase of the baseline platelet count and absence of bleeding)
Early response.
Proportion of patients achieving platelet count ≥30 × 10\^9/L and at least doubling baseline at 1 week after treatment initiation.
Initial response
Proportion of patients achieving platelet count ≥30 × 10\^9/L and at least doubling baseline at 1 month after treatment initiation.
overall response(OR) rate at week 12
Proportion of patients achieving complete response (CR) plus response (R) at Week 12
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