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 × 109/l, or < 50 × 109/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, the 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.

• Authors: Ken Takase, Hirokazu Nagai, Moe Kadono, Takanori Yoshioka, Nobuyuki Yoshio, Yukio Hirabayashi, Takuo Ito, Morio Sawamura, Akihiro Yokoyama, Shinichiro Yoshida, Ikuyo Tsutsumi, Maki Otsuka, Youko Suehiro, Michihiro Hidaka, Isao Yoshida, Hisayuki Yokoyama, Hitoshi Inoue, Hiroatsu Iida, Maki Nakayama, Terutoshi Hishita, Hiromi Iwasaki, Akiko Kada, Akiko M Saito, Yoshiaki Kuroda
• Journal: International journal of hematology (Int J Hematol) Vol. 111 Issue 3 Pg. 388-395 (Mar 2020) ISSN: 1865-3774 [Electronic] Japan
• PMID: 31897888 (Publication Type: Case Reports, Letter)

Chemical References

• Dexamethasone

Topics

• Adult
• Dexamethasone (administration & dosage)
• Humans
• Male
• Pulse Therapy, Drug
• Purpura, Thrombocytopenic, Idiopathic (drug therapy)
• Treatment Outcome