High Doses of Dexamethasone in Adult Patients with Idiopathic Thrombocytopenic Purpura

Gutiérrez-Espı́ndola, Guillermo; Morales-Polanco, M R; Guerrero-Rivera, Susana; Talavera, Juan O.; Sánchez-Valle, Elizabeth; Gómez-Morales, Enrique; Pizzuto-Chávez, J

doi:10.1016/s0188-4409(02)00464-2

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…In the literature, maintenance treatment was used in some [11] but not other reports [7,8,9,10]. The dosage of glucocorticoids for maintenance treatment was also different among reports.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, high-dose dexamethasone (HD-DXM) in 4-day cycles has proven its clinical efficacy in the treatment of ITP. However, there are still many unresolved problems: (1) whether HD-DXM is used as an initial treatment for newly diagnosed ITP [4,5,6] or just for refractory ITP [7,8,9,10]; (2) how many courses of HD-DXM are suitable for patients, as the number of HD-DXM courses reported ranges from 1 to 6 courses [4,5,8,11], and (3) whether maintenance treatment with low-dose glucocorticoids is needed between pulsed HD-DXM courses and after the total HD-DXM courses [5,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

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Long-Term Effect of High-Dose Dexamethasone with or without Low-Dose Dexamethasone Maintenance in Untreated Immune Thrombocytopenia

din¹,

Wang

Shi³

et al. 2014

Acta Haematol

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Background: To tackle the problems associated with high-dose dexamethasone (HD-DXM) in patients with immune thrombocytopenia (ITP). Aim: To compare the efficacy of HD-DXM with or without low-dose dexamethasone maintenance in untreated ITP patients. Results: Dexamethasone (40 mg/day) was given in 4-day pulses every 14 days for 3 cycles in 61 patients with ITP. Among them, 30 cases were given dexamethasone (0.035 mg/kg per day) for maintenance between pulsed HD-DXM and after 3 HD-DXM courses (HD-DXM-M group) and another 31 cases did not receive dexamethasone maintenance (HD-DXM-nM group). The control group comprised the patients who received prednisone (prednisone group). The following results were obtained: (1) at the end of the 3rd cycle, the overall response rate (ORR) was higher in the HD-DXM group than in the prednisone group; (2) the ORR of the HD-DXM group peaked after the 3rd cycle; (3) the ORR after each course was higher in the HD-DXM-M group than in the HD-DXM-nM group; (4) in the 12th month after HD-DXM discontinuation, the relapse rate of the HD-DXM-M group was lower than that of the other groups (prednisone and HD-DXM-nM). Conclusion: Treatment with 3 cycles of HD-DXM pulses with low-dose dexamethasone maintenance is an effective method for untreated ITP.

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“…In the literature, maintenance treatment was used in some [11] but not other reports [7,8,9,10]. The dosage of glucocorticoids for maintenance treatment was also different among reports.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Effect of High-Dose Dexamethasone with or without Low-Dose Dexamethasone Maintenance in Untreated Immune Thrombocytopenia

din¹,

Wang

Shi³

et al. 2014

Acta Haematol

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“…Subsequent studies failed to demonstrate such efficacy. Though it is difficult to compare the results of different studies [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], the response rates have varied from none to 85% (Table II). The side effect profile was also different in different studies.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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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).

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“…High dose corticosteroids, IVIg, TPO receptor agonists or platelet transfusions are useful for this purpose. In patients who have failed previous ITP treatments, including splenectomy, high dose dexamethasone may be useful to achieve rapid (within weeks) platelet count rises but responses are generally not durable (Gutierrez‐Espindola et al , 2003) and side effects may be limiting (Warner et al , 1997). In an observational study of 10 patients who had failed at least two prior ITP treatments, including six who had failed splenectomy, treatment with high dose dexamethasone (40 mg/d for 4 d, given every 4 weeks for 6 cycles) achieved a rapid platelet count increase that was maintained for up to 6 months in most patients (Andersen, 1994).…”

Section: Rational Approach To Treatment Of Chronic Itpmentioning

confidence: 99%

Pathophysiology and management of chronic immune thrombocytopenia: focusing on what matters

Toltl

Arnold

2010

Br J Haematol

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SummaryImmune thrombocytopenia (ITP) is a common autoimmune disease characterized by low platelet counts and an increased risk of bleeding. Antibody-mediated platelet destruction has been the prevailing hypothesis to explain ITP pathogenesis, supported by the efficacy of B-cell depletion therapy; however, the recent success of thrombopoietin receptor agonists lends support to the notion that platelet production is also insufficient. Best practice for the management of chronic ITP has not yet been established because data from comparative trials are lacking. Despite renewed interest in novel drugs capable of increasing platelet counts, ultimate treatment goals for ITP patients must be kept in mind: to improve patients' health and well-being. In this article, the pathophysiology of ITP is reviewed and key remaining questions about mechanism are explored. A rational approach to the management of ITP in adults is outlined, acknowledging evidence and evidence gaps, and highlighting the need for clinically important endpoints in future clinical trials.

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High Doses of Dexamethasone in Adult Patients with Idiopathic Thrombocytopenic Purpura

Cited by 10 publications

References 20 publications

Long-Term Effect of High-Dose Dexamethasone with or without Low-Dose Dexamethasone Maintenance in Untreated Immune Thrombocytopenia

Long-Term Effect of High-Dose Dexamethasone with or without Low-Dose Dexamethasone Maintenance in Untreated Immune Thrombocytopenia

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

Pathophysiology and management of chronic immune thrombocytopenia: focusing on what matters

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