High-dose dexamethasone or oral prednisone for immune thrombocytopenia?

Abstract

Immune thrombocytopenia is an acquired bleeding disorder characterised by antibody-mediated destruction of platelets and impaired thrombopoiesis. Patients who are severely affected show haemorrhagic signs due to thrombocytopenia. In most guidelines and recommendations, a short course of oral prednisone is considered first-line treatment (ie, 0·5–2·0 mg/kg per day for 2–3 weeks, then tapered over a few weeks). 1 Provan D Stasi R Newland AC et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010; 115: 168-186 Crossref PubMed Scopus (1449) Google Scholar , 2 Neunert C Lim W Crowther M Cohen A Solberg Jr, L Crowther MA American Society of HematologyThe American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011; 117: 4190-4207 Crossref PubMed Scopus (1342) Google Scholar All guidelines emphasise avoiding long-term corticosteroids because of side-effects. High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysisIn adults with previously untreated immune thrombocytopenia, high-dose dexamethasone did not improve durable platelet count responses compared with standard-dose prednisone. High-dose dexamethasone might be preferred over prednisone for patients with severe immune thrombocytopenia who require a rapid rise in platelet count. Full-Text PDF