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

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.