High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults

Borst, F.; Keuning, J.J.; Hulsteijn, Harry van; Sinnige, Harm; Vreugdenhil, Gerard

doi:10.1007/s00277-004-0908-1

Cited by 51 publications

(44 citation statements)

References 24 publications

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“…We have obtained a persistent response rate of 66.7% (32/48 evaluable adult patients) without any therapy, whereas in the Cheng et al study a persistent response rate of 42% was reported. 21 Furthermore, our data seem to be similar to those of Borst et al, 23 who more recently reported a long-term response of 59%. However, they observed an adverse event rate of 22%, and in our 2 studies adverse event rates were 13.5% and 2.1%, respectively.…”

Section: Discussionsupporting

confidence: 79%

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience

Mazzucconi

Fazi

Bernasconi

et al. 2006

Blood

232

181

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In idiopathic thrombocytopenic purpura (ITP), corticosteroids have been widely recognized as the most appropriate firstline treatment, even if the best therapeutic approach is still a matter of debate. Recently, a single high-dose dexamethasone (HD-DXM) course was administered as first-line therapy in adult patients with ITP. In this paper we show the results of 2 prospective pilot studies (monocentric and multicentric, respectively) concerning the use of repeated pulses of HD-DXM in untreated ITP patients. In the monocenter study, 37 patients with severe ITP, age at least 20 years and no more than 65 years, were enrolled. HD-DXM was given in 4-day pulses every 28 days, for 6 cycles. Response rate was 89.2%; relapse-free survival (RFS) was 90% at 15 months; long-term responses, lasting for a median time of 26 months (range 6-77 months) were 25 of 37 (67.6%). In the multicenter study, 95 patients with severe ITP, age at least 2 years and no more than 70 years, were enrolled. HD-DXM was given in 4-day pulses every 14 days, for 4 cycles; 90 patients completed 4 cycles. Response rate (85.6%) was similar in patients classified by age (< 18 years, 36 of 42 ‫؍‬ 85.7%; > 18 years, 41 of 48 ‫؍‬ 85.4%, P ‫؍‬ not significant), with a statistically significant difference between the second and third cycle (75.8% vs 89%, P ‫؍‬ .018). RFS at 15 months 81%; long-term responses, lasting for a median time of 8 months (range 4-24 months) were 67 of 90 (74.4%). In both studies, therapy was well tolerated. A schedule of 3 cycles of HD-DXM pulses will be compared with standard prednisone therapy (eg, 1 mg/kg per day) in the next randomized Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) trial. (Blood.

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Section: Discussionsupporting

confidence: 79%

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience

Mazzucconi

Fazi

Bernasconi

et al. 2006

Blood

232

181

View full text Add to dashboard Cite

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“…Even with the difference of the criteria of response and the number of cycles of HD-Dexa, an initial response was obtained in more than 70% in the untreated groups. In the present analysis HD-Dexa regimens yielded a similar good response in comparison with historical data (3)(4)(5)8). Meanwhile, as to time to next treatment, the duration time was short for the untreated ITP patients.…”

Section: Discussionsupporting

confidence: 66%

Comparison between Pulsed High-Dose Dexamethasone and Daily Corticosteroid Therapy for Adult Primary Immune Thrombocytopenia: A Retrospective Study

et al. 2012

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Objective Recently, pulsed high-dose dexamethasone (HD-Dexa) therapy was proposed as a possible alteration for the classical prednisolone (PSL) therapy for primary immune thrombocytopenia (ITP) patients, however it remains to be confirmed which of these remedies is superior. So the objective of this study is to compare the efficacy and the sustainability of these options. Methods The first-line therapy at our institute for untreated adult ITP cases was accordingly changed as follows, and we retrospectively evaluated the outcomes: 1) daily administration of 0.5-1 mg/kg PSL for 2-4 weeks and subsequently stepwise reduction, 2) one course of HD-Dexa (40 mg/day for four consecutive days, 1xHD-Dexa), 3) three courses of the same dose of HD-Dexa (3xHD-Dexa) repeated biweekly. This study was approved by the ethical committee of the University of Tokyo. Results Twenty-five patients were enrolled consecutively. A good initial response was attained through all the regimens. Meanwhile, time to next treatment for lack of response or relapse was significantly longer in the PSL group than in the other groups (log-rank test, PSL vs. 1xHD-Dexa p<0.001, PSL vs. 3xHD-Dexa p= 0.0053, respectively). Additionally, PSL regimen conferred a significantly longer duration time of response (PSL vs. 1xHD-Dexa p=0.0024, PSL vs. 3xHD-Dexa p=0.028, respectively) and CR (PSL vs. 1xHD-Dexa p=0.012, PSL vs. 3xHD-Dexa p=0.0090, respectively). No patient discontinued the treatment due to side effects in this study. Conclusion PSL regimen was considered to be superior to pulsed HD-Dexa regimens in the sustainability of response.

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“…8 One study showed that a single 4-day cycle of dexamethasone at 40 mg/day was often effective in treating ITP patients at diagnosis; 8 however, treatment with dexamethasone is less effective in patients with persistent and especially chronic ITP. [9][10][11] Another study demonstrated that three or more 4-day cycles of dexamethasone were more efficacious than one cycle. 12 Rituximab is a monoclonal antibody that binds to the CD20 antigen present on B lymphocytes.…”

Section: Introductionmentioning

confidence: 99%

Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration

et al. 2014

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Adults with newly diagnosed or persistent immunothrombocytopenia frequently relapse upon tapering steroids; adults and children with chronic disease have an even lower likelihood of lasting response. In adults with newlydiagnosed immunothrombocytopenia, two studies showed that dexamethasone 40 mg/day x four days and 4 rituximab infusions were superior to dexamethasone alone. Studies have also shown three cycles of dexamethasone are better than one and patients with persistent/chronic immunothrombocytopenia respond less well to either dexamethasone or rituximab. Therefore, 375 mg/m 2 x 4 rituximab was combined with three 4-day cycles of 28 mg/m 2 (max. 40 mg) dexamethasone at 2-week intervals and explored in 67 ITP patients. Best long-term response was assessed as complete (platelet count ≥100x10 9 /L) or partial (50-99x10 9 /L). Only 5 patients had not been previously treated. Fifty achieved complete (n=43, 64%) or partial (n=7, 10%) responses. Thirty-five of 50 responders maintained treatment-free platelet counts over 50x10 9 /L at a median 17 months (range 4-67) projecting 44% eventfree survival. Duration of immunothrombocytopenia less than 24 months, achieving complete responses, and being female were associated with better long-term response (P<0.01). Adverse events were generally mild-moderate, but 3 patients developed serum sickness and 2 colitis; there were no sequelae. Dexamethasone could be difficult to tolerate. Fourteen patients became hypogammaglobulinemic and half had increased frequency of minor infections; 9 of 12 evaluable patients recovered their IgG levels. Rituximab combined with three cycles of dexamethasone provides apparently better results to reported findings with rituximab alone, dexamethasone alone, or the combination with one cycle of dexamethasone. The results suggest medical cure may be achievable in immunothrombocytopenia, especially in women and in patients within two years of diagnosis. (clinicaltrials.gov identifier:02050581) Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration

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High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults

Cited by 51 publications

References 24 publications

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience

Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience

Comparison between Pulsed High-Dose Dexamethasone and Daily Corticosteroid Therapy for Adult Primary Immune Thrombocytopenia: A Retrospective Study

Rituximab and three dexamethasone cycles provide responses similar to splenectomy in women and those with immune thrombocytopenia of less than two years duration

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