The recommendation wording has been updated in line with NICE’s existing wording conventions and the wording used in NICE technology appraisal guidance 293: Eltrombopag for treating chronic immune (idiopathic) thrombocytopenic purpura (review of technology appraisal 205).

NICE recommends romiplostim as a possible treatment for some adults with chronic ITP (see below).

Who can have romiplostim?

You should be able to have romiplostim if you have had your spleen removed, or if you have not had your spleen removed because you can’t have the operation, only if:

  • your chronic ITP has not improved even though you have tried other available treatments or
  • you have severe chronic ITP and a high risk of bleeding that needs frequent courses of treatment.

You can ask your specialist to explain whether romiplostim is appropriate for you.

Why has NICE said this?

NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended romiplostim for people with chronic ITP who meet the criteria listed above because it works better than other treatments available on the NHS. Although it also costs more than other treatments, this was justified by the benefits it provided.

Romiplostim has a marketing authorisation 'for adult chronic immune (idiopathic) thrombocytopenic purpura (ITP) splenectomised patients who are refractory to other treatments (e.g. corticosteroids, immunoglobulins)'. The marketing authorisation also states that romiplostim 'may be considered as second line treatment for adult non-splenectomised patients where surgery is contra-indicated'.  NICE can make recommendations only within a product’s marketing authorisation. The recommendations in section 1 of this guidance are only for people whose condition meets the criteria of the marketing authorisation.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)