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

din, B. Sj; Wang, Xingwen; Shi, Yuye; Li, Yufeng

doi:10.1159/000362529

Cited by 41 publications

(57 citation statements)

References 12 publications

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“…13 Retrospective studies comparing the 2 approaches in smaller cohorts yielded conflicting results [14][15][16] ; thus, RCTs directly comparing these 2 corticosteroid regimens are required to provide higher level evidence of efficacy. The design of this study was based on the standardized definitions and outcome criteria of the IWG.…”

Section: Discussionmentioning

confidence: 99%

High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

Wei

Wang

et al. 2016

Blood

175

166

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Key Points• HD-DXM is a preferred strategy to conventional prednisone as first-line management of newly diagnosed adult primary ITP.This study compared the efficacy and safety of high-dose dexamethasone (HD-DXM) and conventional prednisone (PDN) on the largest cohort to date as first-line strategies for newly diagnosed adult primary immune thrombocytopenia (ITP). Patients enrolled were randomized to receive DXM 40 mg/d for 4 days (n 5 95, nonresponders received an additional 4-day course of DXM) or prednisone 1.0 mg/kg daily for 4 weeks and then tapered (n 5 97). One or 2 courses of HD-DXM resulted in a higher incidence of overall initial response (82.1% vs 67.4%, P 5 .044) and complete response (50.5% vs 26.8%, P 5 .001) compared with prednisone. Time to response was shorter in the HD-DXM arm (P < .001), and a baseline bleeding score ‡8 was associated with a decreased likelihood of initial response. Sustained response was achieved by 40.0% of patients in the HD-DXM arm and 41.2% in the PDN arm (P 5 .884). Initial complete response was a positive indicator of sustained response, whereas presence of antiplatelet autoantibodies was a negative indicator. HD-DXM was generally tolerated better. We concluded that HD-DXM could be a preferred corticosteroid strategy for first-line management of adult primary ITP. This study is registered at www.clinicaltrials.gov as #NCT01356511. (Blood. 2016;127(3):296-302)

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Section: Discussionmentioning

confidence: 99%

High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

Wei

Wang

et al. 2016

Blood

175

166

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“…Lasting responses were frequent in the initial report [3], but subsequent studies were unable to confirm this finding [4,5,6,7,8,9]. Modifications of the regimen have also been used as a first-line approach [9,10,11,12,13,14,15,16,17]. In 2002, we embarked on a prospective, open-label, randomized, multicenter trial comparing standard prednisone with six cycles of pulsed dexamethasone in treatment-naïve adults with ITP (Essen ITP Study, EIS 2002).…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Daily Prednisone versus Pulsed Dexamethasone in Treatment-Naïve Adult Patients with Immune Thrombocytopenia: EIS 2002 Study

Matschke

Müller-Beißenhirtz²,

Novotný³

et al. 2016

Acta Haematol

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Oral prednisone is considered the standard first-line therapy of adult immune thrombocytopenia, but its long-term efficacy is limited. We performed a prospective, randomized, multicenter trial comparing daily prednisone (1-2 mg/kg/day for 2-4 weeks with subsequent dose reduction) with six 3-week cycles of pulsed dexamethasone (0.6 mg/kg/day, days 1-4). The primary endpoint was remission duration. Of 26 patients enrolled, 22 were evaluable for response. Nine were treated with prednisone and 13 with dexamethasone. The median follow-up was 46 months. The initial response rate (PLT ≥50 × 10⁹/l) was 100% in both groups. Long-term remissions were significantly more frequent with pulsed dexamethasone than with daily prednisone (12 months posttreatment: 77 vs. 22%; p = 0.027). The side effects were similar, but patients on dexamethasone suffered significantly more often from insomnia, while patients on prednisone tended to have more infectious complications. Although the cumulative cortisol equivalent dose was comparable during the first 4 weeks of therapy, it was significantly higher in the dexamethasone arm than in the prednisone arm during the ensuing treatment period. We conclude that repeated cycles of pulsed dexamethasone are a good alternative to daily prednisone as a first-line treatment of immune thrombocytopenia. The duration and intensity of glucocorticoid therapy are important determinants of treatment outcome.

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“…1a). [6][7][8][9][10]13,14 This tendency was the same if analyzed with the random-effects model (RR, 1.23; 95% CI, 0.84-1.79; p ¼ 0.28).…”

Section: Sustained Responsementioning

confidence: 71%

“…The primary search yielded 157 citations, of which 7 RCTs met the inclusion criteria. [6][7][8]10,[12][13][14] A search of conference proceedings revealed one additional relevant study (abstract only). 9 In total, we included eight RCTs totaling 704 patients with acute primary ITP (κ ¼ 0.83).…”

Section: Identification Of Studiesmentioning

confidence: 99%

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

Cited by 41 publications

References 12 publications

High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

A Randomized Trial of Daily Prednisone versus Pulsed Dexamethasone in Treatment-Naïve Adult Patients with Immune Thrombocytopenia: EIS 2002 Study

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