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Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia

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DOI: 10.4236/ojbd.2012.24016    4,257 Downloads   7,569 Views   Citations

ABSTRACT

Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the definition of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%; P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM produced longer response duration compared to a conventional dose of prednisone. Randomized clinical trials are warranted to establish the optimal initial steroid therapy for adult ITP.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

M. Teramura, M. Ishiyama, H. Kazama, K. Yoshinaga, M. Shiseki, N. Mori and T. Motoji, "Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia," Open Journal of Blood Diseases, Vol. 2 No. 4, 2012, pp. 85-89. doi: 10.4236/ojbd.2012.24016.

References

[1] F. Rodeghiero, R. Stasi, T. Gernsheimer, M. Michel, D. Provan and D. M. Arnold, et al., “Standardization of Terminology, Definitions and Outcome Criteria in Immune Thrombocytopenic Purpura of Adults and Children: Report from an International Working Group,” Blood, Vol. 113, No. 11, 2009, pp. 2386-2393. doi:10.1182/blood-2008-07-162503
[2] S. Bellucci, Y. Charpak, C. Chastang and G. Tobelem, “Low Doses V Conventional Doses of Corticoids in Immune Thrombocytopenic Purpura (ITP): Results of a Randomized Clinical Trial in 160 Children, 223 Adults,” Blood, Vol. 71, No. 4, 1988, pp. 1165-1169.
[3] D. B. Cines and V. S. Blanchette, “Immune Thrombocytopenic Purpura,” New England Journal of Medicine, Vol. 346, No. 13, 2002, pp. 995-1008. doi:10.1056/NEJMra010501
[4] J. N. George, M. A. EL-Harake and G. E. Raskob, “Chronic Idiopathic Thrombocytopenic Purpura,” New England Journal of Medicine, Vol. 331, No. 18, 1994, pp. 1207-1211. doi:10.1056/NEJM199411033311807
[5] J. N. George, S. H. Woolf, G. E. Raskob, J. S. Wasser, L. M. Aledort and P. J. Ballem, et al., “Idiopathic Thrombocytopenic Purpura: A Practice Guideline Developed by Explicit Methods for the American Society of Hematology,” Blood, Vol. 88, No. 1, 1996, pp. 3-40.
[6] M. G. Mazzucconi, M. Francesconi, P. Fidani, G. Di Nucci, G. M. Gandolfo and A. Afeltra, et al., “Treatment of Idiopathic Thrombocytopenic Purpura (ITP): Results of a Multicentric Protocol,” Haematologica, Vol. 70, No. 4, 1985, pp. 329-336.
[7] J. E. Portielje, R. G. Westendorp, H. C. Kluin-Nelemans and A. Brand, “Morbidity and Mortality in Adults with Idiopathic Thrombocytopenic Purpura,” Blood, Vol. 97, No. 9, 2001, pp. 2549-2554. doi:10.1182/blood.V97.9.2549
[8] J. C. Andersen, “Response of Resistant Idiopathic Thrombocytopenic Purpura to Pulsed High-Dose Dexamethasone Therapy,” New England Journal of Medicine, Vol. 330, No. 22, 1994, pp. 1560-1564. doi:10.1056/NEJM199406023302203
[9] I. Khouri, B. Tuan and K. Grant, “Comment on: Immune Thrombocytopenic Purpura,” New England Journal of Medicine, Vol. 347, No. 6, 2002, pp. 449-450. doi:10.1056/NEJM200208083470617
[10] M. Warner, P. Wasi, S. Couban, C. Hayward, T. Warkentin and J. D. Kelton, “Failure of Pulse High-Dose Dexamethasone in Chronic Idiopathic Immune Thrombocytopenia,” American Journal of Hematology, Vol. 54, No. 4, 1997, pp. 267-270. doi:10.1002/(SICI)1096-8652(199704)54:4<267::AID-AJH1>3.0.CO;2-T
[11] Y. Cheng, R. S. Wong, Y. O. Soo, C. H. Chui, F. Y. Lau, N. P. Chan, et al., “Initial Treatment of Immune Thrombocytopenic Purpura with High-Dose Dexamethasone,” New England Journal of Medicine, Vol. 349, No. 9, 2003, pp. 831-836. doi:10.1056/NEJMoa030254
[12] F. Borst, J. J. Keuning, H. van Hulsteijn, H. Sinnige and G. Vreugdenhil, “High-Dose dexamethasone as a Firstand Second-Line Treatment of Idiopathic Thrombocytopenic Purpura in Adults,” Annals of Hematology, Vol. 83, No. 12, 2004, pp. 764-768. doi:10.1007/s00277-004-0908-1
[13] M. G. Mazzucconi, P. Fazi, S. Bernasconi, G. De Rossi, G. Leone and L. Gugliotta, et al., “Therapy with HighDose Dexamethasone (HD-DXM) in Previously Untreated Patients Affected by Idiopathic Thrombocytopenic Purpura: A GIMEMA Experience,” Blood, Vol. 109, No. 4, 2007, pp. 1401-1407. doi:10.1182/blood-2005-12-015222
[14] E. L. Kaplan and P. Meier, “Nonparametric Estimation from Incomplete Observations,” Journal of the American Statistical Association, Vol. 53, No. 282, 1958, pp. 457481. doi:10.2307/2281868
[15] C. Guo, X. Chu, Y. Shi, W. He, L. Li and L. Wang, et al., “Correction of Th1-Dominant Cytokine Profiles by High-Dose Dexamethasone in Patients with Chronic Idiopathic Thrombocytopenic Purpura,” Journal of Clinical Immunology, Vol. 27, No. 6, 2007, pp. 557-562. doi:10.1007/s10875-007-9111-1
[16] N. N. Shan, X. J. Zhu, Q. Wang, C. Y. Wang, P. Qin and J. Peng, et al., “High-Dose Dexamethasone Regulates Interleukin-18 and Interleukin-18 Binding Protein in Idiopathic Thrombocytopenic Purpura,” Haematologica, Vol. 94, No. 11, pp. 1603-1607. doi:10.3324/haematol.2009.007708
[17] X. G. Liu, S. H. Ma, J. Z. Sun, J. Ren, Y. Shi and L. Sun, et al., “High-Dose Dexamethasone Shifts the Balance of Stimulatory and Inhibitory Fcgamma Receptors on Monocytes in Patients with Primary Immune Thrombocytopenia,” Blood, Vol. 117, No. 6, 2011, pp. 2061-2069. doi:10.1182/blood-2010-07-295477
[18] X. X. Chu, B. H. Huang, X. L. Zhang, L. M. Chen, Y. Wang and W. L. Yu, et al., “Dexamethasone Inhibits Immunoreactivity of Dendritic Cells in Patients with Chronic Idiopathic Thrombocytopenic Purpura,” Blood Coagulation & Fibrinolysis, Vol. 21, No. 6, 2010, pp. 564-567. doi:10.1097/MBC.0b013e32833c2b8c
[19] X. J. Zhu, Y. Shi, J. Z. Sun, N. N. Shan, J. Peng and C. S. Guo, et al., “High-Dose Dexamethasone Inhibits BAFF Expression in Patients with Immune Thrombocytopenia,” Journal of Clinical Immunology, Vol. 29, No. 5, 2009, pp. 603-610. doi:10.1007/s10875-009-9303-y
[20] Y. Ling, X. Cao, Z. Yu and C. Ruan, “Circulating Dendritic Cells Subsets and CD4+ Foxp3+ Regulatory TCells in Adult Patients with Chronic ITP before and after Treatment with High-Dose Dexamethasome,” European Journal of Haematology, Vol. 79, No. 4, 2007, pp. 310316. doi:10.1111/j.1600-0609.2007.00917.x
[21] F. Zaja, M. Baccarani, P. Mazza, M. Bocchia, L. Gugliotta and A. Zaccaria et al., “Dexamethasone plus Rituximab Yields Higher Sustained Response Rates than Dexamethasone Monotherapy in Adults with Primary Immune Thrombocytopenia,” Blood, Vol. 115, No. 14, 2010, pp. 2755-2762. doi:10.1182/blood-2009-07-229815
[22] K. Fujimura, M. Kuwana, Y. Kurata, M. Imamura, H. Harada and H. Sakamaki, et al., “Is Eradication Therapy Useful as the First Line of Treatment in Helicobacter Pylori-Positive Idiopathic Thrombocytopenic Purpura? Analysis of 207 Eradicated Chronic ITP Cases in Japan,” International Journal of Hematology, Vol. 81, No. 2, 2005, pp. 162-168. doi:10.1532/IJH97.04

  
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