An accompanying Comment article notes that this is the first RCT of rituximab as a second-line drug in patients with steroid relapsed or refractory immune thrombocytopenia. The authors suggest that absence of a substantial long-term response raises important questions about the role of B-cell depleting therapy, particularly in the era of alternative treatments, such as the thrombopoietin receptor agonists. They add that judgments about the potential benefits of rituximab should be balanced by adverse effects, namely infectious risks. They call for further research into other clinically significant endpoints and for a larger study size to enable subgroup analysis that might allow identification of a population of patients in whom rituximab does give real benefits. Further studies are also warranted to explore use in combination with steroids and use as maintenance therapy.