High-dose dexamethasone therapy as the initial treatment for idiopathic thrombocytopenic purpura

Abstract

There is a controversy which short term high dose dexamethasone therapy (HDD) or standard dose prednisolone therapy as the initial treatment leads to long term efficacy in idiopathic thrombocytopenic purpura (ITP) patients. We conducted a multicenter, prospective trial to determine the efficacy and safety of short-term HDD in ITP patients aged 18-80 years with platelet counts of <20 × 10 9 /L, or <50 × 10 9 /L and bleeding symptoms.The primary endpoints are the proportion of complete response (CR) plus partial response (R) on day 180 after the completion of the 46-day HDD.Twenty-three patients were enrolled. Test for Helicobacter pylori (H.pylori) was positive for 6 patients, and negative for 17 patients. In positive patients, 5 were received successful H.pylori eradication therapy. The proportion of CR+R was 60.9% (14/23) with 90% confidence interval of 41.7-77.8%. For patients with positive H.pylori and successful eradication, proportion of CR+R was 80.0% (4/5). There was one grade 4 adverse event. Although we have enrolled relatively old, severe ITP patients with a median age of 63 years in this study, the efficacy was comparable to the reported clinical trials with HDD therapy.

Tacrolimus is effective in relapsed/refractory autoimmune cytopenias: results of a single-center retrospective study

“…For ITP, complete response (CR) was defined as platelet count ≥100 × 10 9 /L and absence of bleeding; partial response (PR) was defined as platelet count ≥30 × 10 9 /L and absence of bleeding or at least a doubling of the baseline platelet count; and no response (NR) was defined as any platelet count lower than 30 × 10 9 /L or less than doubling of the baseline count [1,10]. For AIHA, CR was defined as a normal hemoglobin level in the absence of any recent transfusion and ongoing hemolysis; PR was defined as hemoglobin level ≥100 g/L or at least a 20 g/L increase from the pretreatment level; and NR was defined as hemoglobin level ≤100 g/L or an increase less than 20 g/L from the pretreatment level [11].…”

“…Autoimmune cytopenias can be idiopathic or secondary to other diseases. The first-line treatment of autoimmune cytopenias includes corticosteroids and/or intravenous immunoglobulin G (IVIG), with an efficacy of 60-80%, but many patients ultimately relapse [1][2][3][4]. For patients with autoimmune cytopenias, relapse or corticosteroid dependence sometimes can be a bigger problem than no reaction to the treatment because patients can die of toxicities caused by high doses and long-term use of corticosteroids.…”

Purple Thrombocytopenic Thrombotic

“…The decision to end treatment is empirical and must be estimated based on the clinical and laboratory response, with the exception of renal function values, which may remain permanently altered (6) To conclude, it can be said that thrombotic thrombocytopenic purpura, despite being a disease with a low frequency, tends to present a high lethality if an early diagnosis and timely treatment is not carried out. However, on the other hand, plasmapheresis has managed to significantly reduce this mortality, for which the recommendation is that in the presence of a patient with the characteristic symptoms of thrombotic thrombocytopenic purpura, a test for ADAMTS13 if possible and start treatment with plasmapharesis (7).…”

"Idiopathic Thrombocytopenic Purple: Purpose of a Case"

“…Idiopathic purple thrombocytopenia, due to the rarity of its presentation, creates a challenge for its diagnosis because its clinical manifestations do not always begin with the known clinical pentad: fever, thrombocytopenia, microangiopathic hemolytic anemia, neurological abnormalities and kidney involvement, making it difficult timely treatment [4]. The case presented shows us an atypical presentation of idiopathic purple thrombocytopenia characterized by the absence of renal involvement and without alterations in the central nervous system, which is usually the most common presentation of the disease, without a triggering cause [5].…”