High dose dexamethasone therapy shows better responses in acute immune thrombocytopenia than in chronic immune thrombocytopenia

Abstract

Oral high dose dexamethasone (HDD) was given as a single daily dose for four consecutive days, every 14 days for four courses. Twenty-nine patients were enrolled. Overall 20 patients (69%) responded: complete response (CR) was achieved in 16 (55%) patients, partial response (PR) in three (10%) patients and MR in one (3%) patient. In acute immune thrombocytopenic purpura (ITP) response rates after the first, second, third and fourth cycles were as follows: 64% (9/14), 64% (9/14), 79% (11/14), and 85.7% (12/14), respectively. In chronic ITP, overall response rates after the first, second, third and fourth cycles were as follows: 33% (5/15), 40% (6/15), 53% (8/15) and 53% (8/15) respectively. The median time to response was 14 days (4-42 days). Twelve out of 20 patients (5/12 acute ITP and 7/8 chronic ITP) relapsed; median relapse free survival till last follow-up in the remaining eight patients was 130 days (65-365 days).

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

“…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.…”

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

“…Patients had primary ITP, had not received rituximab except in 4 patients, opted for curative therapy of their ITP, and did not have a contraindication to dexamethasone. Patients were treated for platelet counts less than 40x10 9 /L (all but 2 were < 30x10 9 /L); some were initially unable to discontinue previous ITP treatments.…”

“…Thrombocytopenia persisted in 17 of the 18 initially non-responding patients; they received additional ITP treatments. The 18 th patient, however, achieved counts of 30-40 x10 9 /L, was not treated, and later achieved a PR and then a CR.…”

“…Thirty-five (70%) of the 50 responding patients (52% of all patients treated) maintained platelet counts of 50x10 9 /L or more at last visit without further treatment and with median follow up of 20 months (range 4-67 months). Fifteen responders (9 of 43 CRs and 6 of 7 PRs) relapsed at a median of nine months (range 3-31 months).…”

“…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.…”