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ITP Treatments Compared

Name: ITP Treatments Compared
Creator: Jason Hunter
Published: 2026-10-11

6 FDA-approved drugs and 2 in development, side by side from the current prescribing labels. Newest label Jun 2026. Checked October 11, 2026.

Raise platelet production (TPO receptor agonists)Nplate · Promacta · Alvaiz · Doptelet

Slow platelet destructionTavalisse · Wayrilz

Six medicines are FDA approved for adults with immune thrombocytopenia (ITP) whose platelets stayed too low after earlier treatment such as steroids. Four raise platelet production by switching on the thrombopoietin receptor: the weekly clinic injection Nplate and the daily pills Promacta, Alvaiz and Doptelet. Promacta has been sold as generic eltrombopag since May 2025, and Alvaiz is the same drug in a different salt form with different doses, so the 2 cannot be swapped milligram for milligram. Tavalisse and Wayrilz work the other way, slowing the destruction of platelets. Every pivotal trial compared one drug with placebo using its own response measure, so the results do not rank the drugs.

Side by side

6 approved ITP treatments at a glance

How each drug is given, how often, who it is approved for and when it was first approved, from the current FDA label.

Immune Thrombocytopenia treatments compared: route, schedule, approved use and approval date
Drug	How it is given	How often	Approved for	First approved
Nplate romiplostim Amgen	Injection under the skin once a week, given by a healthcare provider	Starts at 1 mcg/kg weekly, adjusted by 1 mcg/kg a week to keep platelets at 50,000 or higher, up to 10 mcg/kg	Adults with ITP after an insufficient response to steroids, immunoglobulins or splenectomy, and children 1 year and older who have had ITP for at least 6 months	August 22, 2008
Promacta eltrombopag olamine (generic since May 2025) Novartis; generics from several makers	Tablet (or oral suspension for young children) once a day	50 mg once daily to start (25 mg for ages 1 to 5, and lower for East or Southeast Asian ancestry or liver impairment), up to 75 mg; apart from dairy and minerals	Adults and children 1 year and older with persistent or chronic ITP after an insufficient response to steroids, immunoglobulins or splenectomy	November 20, 2008
Doptelet avatrombopag Sobi	Tablet once a day with food (sprinkle granules for ages 1 to 5)	20 mg once daily to start, adjusted in dose or frequency, up to 40 mg a day (sprinkle: 10 mg, up to 20 mg)	Adults with chronic ITP and children 1 year and older with persistent or chronic ITP, after an insufficient response to a previous treatment	June 26, 2019
Tavalisse fostamatinib Rigel Pharmaceuticals	Tablet twice a day, with or without food	100 mg twice daily; raised to 150 mg twice daily after 4 weeks if platelets are under 50,000; stopped after 12 weeks without enough response	Adults with chronic ITP after an insufficient response to a previous treatment	April 17, 2018
Alvaiz eltrombopag choline Teva	Tablet once a day, apart from dairy and minerals	36 mg once daily to start (18 mg for East or Southeast Asian ancestry or liver impairment), up to 54 mg; not interchangeable with Promacta mg for mg	Adults and children 6 and older with persistent or chronic ITP after an insufficient response to steroids, immunoglobulins or splenectomy	November 29, 2023
Wayrilz rilzabrutinib Sanofi	Tablet twice a day, with or without food	400 mg twice daily	Adults with persistent or chronic ITP after an insufficient response to a previous treatment	August 29, 2025

The calendar

A year on each ITP treatment

Every dose in a year, drawn to the label schedule, so you can see at a glance how often each one is given.

Nplate

Injection, at a clinic

52 doses a year

Promacta

By mouth, at home

365 doses a year

Doptelet

By mouth, at home

365 doses a year

Tavalisse

By mouth, at home

730 doses a year

Alvaiz

By mouth, at home

365 doses a year

Wayrilz

By mouth, at home

730 doses a year

Counts follow the label schedule for a full year on the maintenance dose. Drugs given in cycles or adjusted to blood tests have no fixed count, so their schedule is written out instead.

The evidence

What the pivotal ITP trials showed

The primary result from the trial each FDA approval rests on, as reported on the label.

Before you compare

How to read the ITP trial results

1
Food rules differ more than you might expect
Promacta, generic eltrombopag and Alvaiz must be taken without a meal or with a low-calcium meal, at least 2 hours before or 4 hours after dairy, antacids and mineral supplements. Doptelet is taken with food. Tavalisse and Wayrilz can be taken with or without food, though Wayrilz should not be combined with acid-reducing PPIs. Nplate is an injection, so food does not matter.
2
Promacta and Alvaiz are the same drug at different doses
Both contain eltrombopag, but Promacta and its generics use the olamine salt and Alvaiz uses the choline salt. The usual ITP starting dose is 50 mg for Promacta and 36 mg for Alvaiz, with maximums of 75 mg and 54 mg. A pharmacy can swap brand Promacta for a generic, but moving to or from Alvaiz needs a new prescription.
3
The trial results are not a ranking
Nplate and Tavalisse counted durable or stable responses late in 24 weeks, RAISE counted weeks with platelets at 50,000 or higher, Doptelet counted cumulative weeks over 6 months, and Wayrilz counted durable response in LUNA 3. The trials enrolled different patients, many of whom had already tried other drugs, so the percentages cannot be compared across rows.
4
Age limits differ
Nplate, Promacta and Doptelet are approved from age 1 for ITP, Alvaiz from age 6, and Tavalisse and Wayrilz for adults only. Doptelet uses a sprinkle form for children under 6, and Promacta has an oral suspension.

Immune Thrombocytopenia pivotal trial results by drug
Drug	Pivotal trial	Primary result
Nplate romiplostim Amgen	2 placebo-controlled trials, 125 adults, with and without a spleen Trial record or paper	Durable platelet response in 61% vs 5% on placebo (spleen intact) and 38% vs 0% (spleen removed) over 24 weeks
Promacta eltrombopag olamine (generic since May 2025) Novartis; generics from several makers	RAISE, 197 adults, 6 months; Study 773B, 114 adults	Platelets at 50,000 or higher an average of 11.3 weeks vs 2.4 on placebo (RAISE); 59% vs 16% reached 50,000 (773B)
Doptelet avatrombopag Sobi	Phase 3, 49 adults, 6 months Trial record or paper	Median 12.4 weeks with platelets at 50,000 or higher vs 0 weeks on placebo; 66% vs 0% reached it by day 8
Tavalisse fostamatinib Rigel Pharmaceuticals	FIT-1 and FIT-2, 150 adults, 24 weeks Trial record or paper	Stable platelet response in 18% vs 0% on placebo (FIT-1) and 16% vs 4% (FIT-2, not statistically significant)
Alvaiz eltrombopag choline Teva	Relies on the Promacta (eltrombopag olamine) trials	Same efficacy data as Promacta, shown in its label
Wayrilz rilzabrutinib Sanofi	LUNA 3, 202 adults, 24 weeks Trial record or paper	Durable platelet response in 23% vs 0% on placebo

Safety

Immune Thrombocytopenia treatment side effects and warnings

Promacta and Alvaiz carry a boxed warning, the FDA's strongest. The rest list their main precautions. Side effect rates show how many people in each drug's trials reported each one, whether or not the drug caused it.

Immune Thrombocytopenia treatments: most common side effects and key warnings from the FDA labels
Drug	Most common side effects	Key warning
Nplate romiplostim Amgen	joint pain 26%, dizziness 17% and trouble sleeping 16%	No boxed warning. Not for myelodysplastic syndromes, where it can speed progression to leukemia; blood clots; loss of response.
Promacta eltrombopag olamine (generic since May 2025) Novartis; generics from several makers	nausea 9%, diarrhea 9% and upper respiratory infection 7%	Boxed warning Boxed warning: severe liver damage; liver tests before starting and during treatment. Also clots and cataracts.
Doptelet avatrombopag Sobi	headache 31%, tiredness 28% and bruising 26%	No boxed warning. Blood clots: 7% of adults with ITP in its studies.
Tavalisse fostamatinib Rigel Pharmaceuticals	diarrhea 31%, high blood pressure 28% and nausea 19%	No boxed warning. High blood pressure, liver test changes, diarrhea, low white cells and harm to an unborn baby.
Alvaiz eltrombopag choline Teva	nausea, diarrhea and upper respiratory infection	Boxed warning Boxed warning: severe liver damage, the same as Promacta. Also clots and cataracts.
Wayrilz rilzabrutinib Sanofi	diarrhea 32%, nausea 20% and headache 18%	No boxed warning. Serious infections, liver injury and harm to an unborn baby; avoid acid-reducing PPIs.

Not yet approved

ITP treatments in clinical trials or approved only abroad

Investigational drugs in Phase 1 to 3 trials, plus drugs approved by regulators outside the United States, shown separately because their results are not from an FDA label. Status as of the date in each row.

Immune Thrombocytopenia drugs in development
Drug	Status	How it works and is given	Pivotal trial	Result so far	What is next
ianalumab Novartis	Phase 3as of October 11, 2026	Antibody against the BAFF receptor that depletes B cells, the source of the antibodies that mark plateletsIV infusion once a month for 4 doses, added to eltrombopag	VAYHIT2, Phase 3, adults who had not responded to first-line steroidsPrimary endpoint: Time to treatment failure ClinicalTrials.gov	Platelets kept at safe levels a median of 13 months on the 9 mg/kg combination vs 4.7 months on eltrombopag plus placebo (Fierce Biotech, December 9, 2025; published in NEJM)	Novartis plans to file for FDA approval in ITP in 2027 with VAYHIT2 and VAYHIT1 Fierce Biotech, December 9, 2025
efgartigimod (Vyvgart) argenx	Approved outside the USas of October 11, 2026	FcRn blocker that lowers the IgG antibodies that destroy plateletsIV infusion	ADVANCE NEXT, Phase 3, adults with primary ITP (US trial recruiting)Primary endpoint: Sustained platelet response ClinicalTrials.gov	Approved in Japan for adults with primary ITP on March 26, 2024, based on the earlier ADVANCE IV trial of 131 adults	ADVANCE NEXT lists primary completion in June 2028 argenx release via BioSpace, March 26, 2024

Cost

Help paying for ITP treatment

Drugmaker copay and free-drug programs, plus charity funds for the condition, checked every week.

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Questions

Immune Thrombocytopenia treatment questions people ask

Alvaiz vs Promacta: what is the difference?

Both contain eltrombopag, but in different salt forms that the body absorbs differently, so the doses are not the same.

Dose: the usual ITP start is 36 mg of Alvaiz against 50 mg of Promacta; maximums are 54 mg and 75 mg.

Ages: Alvaiz is approved from age 6 for ITP, Promacta from age 1.

Rules in common: the same boxed liver warning, the same dairy and mineral timing rule and the same liver tests.

Switching: a pharmacy cannot substitute one for the other; it takes a new prescription and platelet checks.

More: Alvaiz drug page and Promacta drug page

Source: FDA label for Alvaiz, DailyMed; FDA label for Promacta, DailyMed

Is there a generic for Promacta?

Yes. Generic eltrombopag olamine, the same form as Promacta, has been sold in the US since May 2025, when Camber launched the first one.

Dosing: generics are dosed the same as Promacta and a pharmacy can switch between them.

Not a generic: Alvaiz, a different salt form approved separately.

More: Promacta drug page

Source: OncLive, May 14, 2025

Promacta vs Doptelet: what is the difference?

Both are daily pills that push the bone marrow to make platelets, but they differ in food rules and warnings.

Food: Promacta must be kept apart from dairy and minerals; Doptelet is taken with food.

Warnings: Promacta has a boxed warning for liver damage and needs regular liver tests; Doptelet has no boxed warning, and its main warning is blood clots.

Ages: both are approved from age 1 for ITP.

Trials: they were never tested against each other, so neither is shown to work better.

More: Doptelet drug page and Promacta drug page

Source: FDA label for Doptelet, DailyMed; FDA label for Promacta, DailyMed

Nplate vs Promacta: which is better for ITP?

No trial has compared them directly, so neither is shown to be better for everyone.

How given: Nplate is a weekly injection given by a healthcare provider; Promacta is a daily pill at home.

Daily life: Nplate has no food rules, while Promacta must be kept apart from dairy and minerals.

Warnings: Promacta has a boxed liver warning; Nplate's main warnings are progression of myelodysplastic syndromes, clots and loss of response.

More: Nplate drug page and Promacta drug page

Source: FDA label for Nplate, DailyMed; FDA label for Promacta, DailyMed

What is the newest treatment for ITP?

Wayrilz (rilzabrutinib), approved August 29, 2025, is the newest. It is a twice-daily pill that blocks BTK to slow platelet destruction, for adults whose ITP did not respond well enough to an earlier treatment. In LUNA 3, 23% on Wayrilz had a durable platelet response against 0% on placebo. Next in line is ianalumab from Novartis, which Novartis plans to submit to the FDA in 2027.

More: Wayrilz drug page

Source: FDA label for Wayrilz, DailyMed; Fierce Biotech, December 9, 2025

Which ITP medicines are not TPO receptor agonists?

Tavalisse (fostamatinib) and Wayrilz (rilzabrutinib). Both slow the destruction of antibody-coated platelets instead of raising production: Tavalisse blocks SYK and Wayrilz blocks BTK. Both are pills for adults, taken twice a day.

Tavalisse watch-outs: high blood pressure, diarrhea and liver tests.

Wayrilz watch-outs: infections, liver injury and acid-reducing PPIs.

Source: FDA label for Tavalisse, DailyMed; FDA label for Wayrilz, DailyMed

Go deeper

More on Immune Thrombocytopenia at Trial Friend

Sources

Where every number on this page comes from

Approved-drug facts are from the current FDA prescribing information on DailyMed, with the label's effective date. Investigational-drug facts are from ClinicalTrials.gov and the sources named in each row.

Nplate (romiplostim) prescribing information, Amgen, label dated Jun 2026. DailyMed. Pivotal trial: ClinicalTrials.gov
Promacta (eltrombopag olamine (generic since May 2025)) prescribing information, Novartis; generics from several makers, label dated Dec 2025. DailyMed
Doptelet (avatrombopag) prescribing information, Sobi, label dated Aug 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
Tavalisse (fostamatinib) prescribing information, Rigel Pharmaceuticals, label dated Nov 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
Alvaiz (eltrombopag choline) prescribing information, Teva, label dated Jan 2026. DailyMed
Wayrilz (rilzabrutinib) prescribing information, Sanofi, label dated Aug 2025. DailyMed. Pivotal trial: ClinicalTrials.gov
ianalumab, Novartis: ClinicalTrials.gov record; Fierce Biotech, December 9, 2025. Checked October 11, 2026.
efgartigimod (Vyvgart), argenx: ClinicalTrials.gov record; argenx release via BioSpace, March 26, 2024. Checked October 11, 2026.

This page compares what the FDA labels and pivotal trials report. It is not medical advice, and no trial on this page compared these drugs with each other. Written and checked by Jason Hunter; the method is on the editorial standards page.