The HOLISTIC trial is a pragmatic, international, randomized controlled study investigating two commonly used second-line treatment strategies for adults with immune thrombocytopenia (ITP) failing/relaps after steroidtreatment: avatrombopag (a TPO-RA) and rituximab. The trial evaluates sustained platelet response, treatment-free remission, patient-reported outcomes, quality of life, safety, and health-economic outcomes to guide evidence-based treatment decisions in ITP, and a more personalized approach. The trial is open and are including 220 patients randomized 1:1 in 11 centers in Norway, 3 in Sweeden, 4 in Egypt and 2 in Tunisia.