medical report

The leading competitor in this market is rituximab. For initial treatment, combined therapy with rituximab has been shown to increase response rate when compared with prednisolone monotherapy. Rituximab is also recommended for 2nd-line treatment with 70% patients responded and 50% individuals having persistent response for over a year. The cost for standard therapy (4 weeks) is $2,500 and no significant adverse events were reported. However, it remains in randomized phase 3 studies and none of these are open for recruitment.
Third-line options include other immunosuppression agents (e.g mycophenolate, cyclosporine,..) or splenectomy. However, all the studies on the efficacy of these immunosuppressants in AIHA are retrospective, often lack detail and splenectomy is costly (ranges from $10,000-$30,000), invasive and leaves the patient with life-time vulnerability to overwhelming sepsis. Subsequent lines have either a weaker evidence base or greater potential for toxicity.
In comparison, with response rate of 44% in phase II data, fostamatinib (cots $34,500 for a 24 week-therapy) is much more expensive than rituximab when used in the 2nd-line treatment. However, it can be a better choice for 3rd-line treatment when compared to splenectomy regarding AEs reduction and especially, an appropriate option for patients had failed to ≥ 3 lines therapy.