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Wolfgang Miesbach: ISTH 2026 Marks a New Era in Immune Thrombocytopenia Management
Wolfgang Miesbach/LinkedIn
Jul 6, 2026, 12:20

Wolfgang Miesbach: ISTH 2026 Marks a New Era in Immune Thrombocytopenia Management

Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared on LinkedIn:

”ISTH 2026 is going to be really interesting for ITP

Across several oral presentations in the Platelet Disorders / ITP, HIT, PF4 Antibodies session (OC 25.1–25.5), we see how the field is shifting toward faster, more durable responses, better patient‑reported outcomes, and careful safety profiling:

First‑line innovation

OC 25.1 – RODEX study (M.-E. Mingot‑Castellano et al.): A large multicenter phase 3 trial comparing dexamethasone alone vs dexamethasone plus romiplostim as first‑line treatment in newly diagnosed ITP shows higher sustained response off treatment with the combination (ROMDEX), while maintaining fatigue, quality of life and healthcare resource use.

Rapid and durable platelet responses

  • OC 25.2 – ADVANCE IV (Y. Miyakawa, C. Broome, M. Carpenedo, B. González Sánchez and colleagues): IV efgartigimod, an Fc‑engineered IgG1 fragment, demonstrates rapid platelet count increases as early as day 7, with a significantly higher proportion of patients achieving sustained responses versus placebo in the phase 3 trial and its open‑label extension.
  • OC 25.5 – VAYHIT2 (F. Zaja, H. Al‑Samkari, N. Cooper and co‑authors): Ianalumab (anti‑BAFF) added to eltrombopag in second‑line primary ITP leads to rapid, robust and durable platelet responses, enabling tapering and discontinuation of the TPO‑RA in many patients and pointing toward immune‑modulating combinations rather than lifelong stimulation alone.

Safety and long‑term risk

OC 25.3 – LUNA 2/3 integrated analysis (D. Kuter, N. Cooper, Y. Miyakawa, W. Ghanima and colleagues): Rilzabrutinib, a highly selective BTK inhibitor, shows low rates of cardiovascular adverse events and no apparent increase versus placebo despite longer exposure, an important safety signal in adults with persistent/chronic ITP, who already carry elevated thromboembolic risk.

Patient‑reported outcomes and HRQoL

  • OC 25.4 – Mezagitamab phase 2 (S. Wang et al.): The anti‑CD38 antibody mezagitamab in chronic/persistent ITP is associated with early and clinically meaningful improvements across multiple ITP‑PAQ domains (symptoms, physical fatigue, social activities, psychological health, overall QoL), with sustained benefits even after treatment cessation.
  • Together, these ISTH oral abstracts illustrate how future ITP care will balance efficacy, tolerability, comorbidity risk and patient‑reported outcomes—moving from ‘platelet counts only’ toward mechanism‑based, patient‑focused therapy.”

Wolfgang Miesbach: ISTH 2026 Marks a New Era in Immune Thrombocytopenia Management

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bleeding disorders Health Hematology Hemostasis Hemostasis News Hemostasis Today HIT Immune thrombocytopenia ISTH 2026 ITP Medicine Platelet disorders ROMDEX Wolfgang Miesbach
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