Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia

Hiroshi Kazama,Midori Ishiyama,Toshiko Motoji,Naoki Mori,Masayuki Shiseki,Masanao Teramura,Kentaro Yoshinaga

doi:10.4236/ojbd.2012.24016

Abstract

Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%; P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.

Highlights

Primary immune thrombocytopenia (ITP) previously called idiopathic thrombocytopenic purpura is an acquired immune-mediated disorder characterized by isolated thrombocytopenia defined as a peripheral blood platelet count less than 100 × 109/L, and the absence of any obvious initiating and/or underlying cause of the thrombocytopenia [1]
Fifty two patients diagnosed of ITP were analyzed, of whom 30 were treated with prednisone and 22 treated with high-dose dexamethasone (HD-DXM)
We found HD-DXM and prednisone to have nearly identical initial response rates for the treatment of ITP (CR: 68% vs. 70%, and R: 18% vs. 17%)

Summary

Introduction

Primary immune thrombocytopenia (ITP) previously called idiopathic thrombocytopenic purpura is an acquired immune-mediated disorder characterized by isolated thrombocytopenia defined as a peripheral blood platelet count less than 100 × 109/L, and the absence of any obvious initiating and/or underlying cause of the thrombocytopenia [1]. Treatment is generally given for patients with a low platelet count (≤20 × 109/L or ≤30 × 109/L) or clinically significant bleeding. The standard initial treatment for adult patients with ITP is corticosteroids. Prednisone is widely regarded as the standard first-line treatment. If an increase in platelet count is obtained, the dose is gradually tapered. With this approach, an initial response rate of 50% to 60% is obtained, long-term remission rate after discontinuation are very low (10% to 25%) [2,3,4,5,6,7]

Objectives

Results

Conclusion