Korean J Hematol.  2009 Mar;44(1):22-27. 10.5045/kjh.2009.44.1.22.

Initial Therapy with High-Dose Dexamethasone for Patients with Idiopathic Thrombocytopenic Purpura

• Yoon JA
• Kim CK
• Kim SH
• Kim KH
• Kim HJ
• Park SK
• Lee SC
• Lee NS
• Bae SB
• Lee KT
• Won JH
• Park HS
• Hong DS

• KMID: 2252169
• DOI: http://doi.org/10.5045/kjh.2009.44.1.22

Abstract

BACKGROUND: Corticosteroids have been widely used for treatingidiopathic thrombocytopenic purpura (ITP) as a first-line treatment. Several different pulsed high-dose dexamethasone therapies for adult ITP have been reported on. We assessed the effectiveness of a single course of high dose dexamethasone as first-line treatment for adult patients with ITP.
METHODS
The subjects of the study were previously untreated adult patients with newly diagnosed ITP and who had a platelet count of less than 20,000/microliter or a platelet count less than 50,000/microliter. High-dose dexamethasone at a dose of 40mg/day for four consecutive days was given orally. A response was defined as an increase in the platelet count of at least 30,000/microliter and a platelet count of more than 50,000/microliter by day 10 after the initial treatment. A sustained response was defined as a platelet count of more than 50,000/microliter that was maintained for six months after the initial treatment.
RESULTS
Twenty two patients were eligible. The median platelet count before treatment was 19,000/microliter. Seventeen patients (77%) among the 22 patients achieved an initial response by day 10: the mean platelet count 10 days after the initial treatment was 144,000/microliter (range: 51,000 to 428,000/microliter). Among the patients with a response, 4 (23.5%) had a sustained response, and the other 13 (76.5%) relapsed within six months. All the patients well tolerated the high-dose dexamethasone treatment.
CONCLUSION
A single course of high-dose dexamethasone is effective as an initial treatment for adults ITP patients, although the response duration is short. To maintain the response, repeated high-dose dexamethasone treatment may be needed or other alternative therapies can be considered.

Keyword

Idiopathic thrombocytopenic purpura (ITP); Dexamethasone; Treatment

MeSH Terms

Adrenal Cortex Hormones
Adult
Complementary Therapies
Dexamethasone
Humans
Platelet Count
Purpura, Thrombocytopenic
Purpura, Thrombocytopenic, Idiopathic
Adrenal Cortex Hormones
Dexamethasone

Figure

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  Fig. 1. Treatment protocol and results in 22 patients with newly diagnosed idiopathic thrombocytopenic purpura.

Reference

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