The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis

Xiao, Qirong; Lin, Bicun; Wang, Hanyu; Zhan, Weiwu; Chen, Ping

doi:10.3389/fmed.2021.656792

Cited by 10 publications

(13 citation statements)

References 26 publications

(40 reference statements)

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“…Response time to treatment could be an attractive prognostic indicator in ITP, but evidence was lacking. In one study, high dose dexamethasone produced faster platelet response than prednisone (3 to 5 days respectively) but in twelve months follow-up, complete response rates were comparable (32.1 % for high dose dexamethasone and 34.1 % for prednisone) [13]. We also found that faster response time did not produce longer remissions, but faster response time produced significantly higher remission rates, and this was compatible with the literature.…”

Section: Discussionsupporting

confidence: 90%

“…Corticosteroids are the main backbone of first line treatment; prednisolone, methylprednisolone and high dose dexamethasone was used effectively for treatment. High dose dexamethasone seemed to induce faster response and less long-term toxicity compared to prednisone [13], but overall prognosis of the disease did not significantly change in either of treatment and, at 12 months response rates were similar [14]. According to ASH guidelines for immune thrombocytopenia, both can be used as a primary treatment [12].…”

Section: Discussionmentioning

confidence: 99%

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Fast platelet recovery is associated with remission in primary immune thrombocytopenia

HATİP

Ozbalci

Alanoğlu

et al. 2023

The European Research Journal

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Objectives: We aimed to reveal predictors of response and response duration to steroid therapy in first line of treatment in immune thrombocytopenia (ITP). Methods: Fifty patients, who were diagnosed with ITP in hematology department of Suleyman Demirel University Hospital between 2005-2019, who had sufficient clinical and laboratory data, followed up for at least one year and received corticosteroid treatment in first line, were evaluated retrospectively for treatment response time, remission, prognosis on their first line treatment. The patients who maintained remission for more than 12 months was defined as group 1 and those who did not achieve remission or relapsed in less than 12 months were defined as group 2. Results: Twenty-two (44%) patients responded in first 3 days of the treatment, 16 (32%) patients in 4 to 7 days and 4 (8%) patients responded in more than 7 days. Eighty-four percent (n = 42) of these patients had complete response to corticosteroid treatment. When the remission maintenances were examined, it was observed that 22 (44%) patients were in remission for more than 12 months, 20 (40%) patients were in remission with treatment but relapsed before 12 months and 8 (16%) patients did not respond to corticosteroid treatment. When the response time to treatment in patients with or without remission was compared, remission was significantly lower in those who responded late to treatment (p = 0.01). When the response rates to corticosteroid treatment of patients in group 1 and 2 were evaluated, it was found that the response time to treatment was not related to the maintenance of remission (p = 0.267). Conclusions: Faster response time to treatment produced higher remission rates but, we could not find any relationship between response time to treatment and duration of remission.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

HATİP

Ozbalci

Alanoğlu

et al. 2023

The European Research Journal

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show abstract

“… 22 , 29 However, a study by Xiao et al. 30 reported no difference in adverse event or relapse rate between the two regimens, while dexamethasone tend to reach a higher sustained response. Our results are favorable to dexamethasone both in short-term and long-term response, as well as the incidence of grade ≥3 AEs, though they had no obvious statistical difference using pairwise meta-analysis.…”

Section: Discussionmentioning

confidence: 98%

Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: a systematic review and network meta-analysis

Wang¹,

Sheng²,

Han³

et al. 2023

eClinicalMedicine

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“…With additional data on high‐dose dexamethasone treatment available, there was a new metanalysis done by a Chinese group 23 . In arm A they compared HD‐DXM to PDN and in arm B dexamethasone to the combination of rituximab and dexamethasone.…”

Section: Dexamethasone Treatment In Newly Diagnosed Itpmentioning

confidence: 99%

“…With additional data on high-dose dexamethasone treatment available, there was a new metanalysis done by a Chinese group. 23 In arm A they compared HD-DXM to PDN and in arm B dexamethasone to the combination of rituximab and dexamethasone. They found HD-DXM to be superior to PDN in OR at one month [response rate (RR) = 1.12; 95% confidence interval (CI) = 1.03-1.22, p = 0.006] and in sustained response at 12 months (RR = 1.34; 95% CI = 1.06-1.68, p = 0.014).…”

Section: De X a M Eth Ason E Tr E Atm E N T I N N Ew Ly Di Agnose D Itpmentioning

confidence: 99%

Should dexamethasone alone or in combination be the initial steroid for adult ITP: Still a relevant question

Skopec

Bussel

2022

Br J Haematol

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Summary Corticosteroids are used in first‐line treatment in newly diagnosed immune thrombocytopenia. The goal of treatment is primarily to decrease autoantibody‐mediated platelet clearance. Ideally initial treatment would not just increase the platelet count but also provide a long‐term sustained remission. While many clinicians use prednisone (PDN) as their first choice of corticosteroid, others prefer dexamethasone. The controversy is the subject of debates. Short courses of higher‐dose corticosteroids were first reported by the Andersen study in 1994. The study posited high‐dose dexamethasone as a ‘cure’ for all ITP patients. Later, studies addressed the number of dexamethasone cycles, indications to repeat cycles and timing between cycles, with varied long‐term results. The results with dexamethasone were compared to PDN in some studies: the four‐day cycles of dexamethasone work faster in increasing platelet counts and appear to reduce the occurrence of severe adverse events. Therefore, it is probably a better option for patients with low platelet counts and bleeding diathesis; however, curative superiority, the initial reason to administer it, compared to PDN is not well demonstrated. Across the studies, treatment with high‐dose dexamethasone seems to be safer, with lower incidence of all adverse events compared to PDN, which might be a reflection of shorter treatment duration and possibly also lower cumulative steroid dose. Dexamethasone in combination with rituximab in first‐line treatment produced higher response rates with better long‐term results compared to high‐dose dexamethasone alone and is a particularly good option in younger women.

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The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis

Cited by 10 publications

References 26 publications

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

Fast platelet recovery is associated with remission in primary immune thrombocytopenia

Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: a systematic review and network meta-analysis

Should dexamethasone alone or in combination be the initial steroid for adult ITP: Still a relevant question

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