Dapsone, danazol, and intrapartum splenectomy in refractory ITP complicating pregnancy

Varghese, Lilly; Viswabandya, Auro; Mathew, Arpit Jacob

doi:10.4103/0019-5359.44483

Cited by 9 publications

(4 citation statements)

References 8 publications

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“…Multiple case reports about the use of dapsone in a variety of diseases support the assumption of innocuousness. [39, 50, 76, 97, 105, 106, 109, 154, 158]. In any case, the risk of not treating the mother must be weighed up against the risk for the fetus.…”

Section: Conclusion For Treating Patients With Dapsonementioning

confidence: 99%

Dapsone in dermatology and beyond

2013

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Dapsone (4,4′-diaminodiphenylsulfone) is an aniline derivative belonging to the group of synthetic sulfones. In 1937 against the background of sulfonamide era the microbial activity of dapsone has been discovered. Shortly thereafter, the use of dapsone to treat non-pathogen-caused diseases revealed alternate antiinflammatory mechanisms that initially were elucidated by inflammatory animal models. Thus, dapsone clearly has dual functions of both: antimicrobial/antiprotozoal effects and anti-inflammatory features similarly to non-steroidal anti-inflammatory drugs. The latter capabilities primarily were used in treating chronic inflammatory disorders. Dapsone has been investigated predominantly by in vitro methods aiming to get more insights into the effect of dapsone to inflammatory effector cells, cytokines, and/or mediators, such as cellular toxic oxygen metabolism, myoloperoxidase-/halogenid system, adhesion molecules, chemotaxis, membrane-associated phospholipids, prostaglandins, leukotrienes, interleukin-8, tumor necrosis factor α, lymphocyte functions, and tumor growth. Moreover, attention has been paid to mechanisms by which dapsone mediates effects in more complex settings like impact of lifespan, stroke, glioblastoma, or as anticonvulsive agent. Additionally, there are some dermatological investigations in human being using dapsone and its metabolites (e.g., leukotriene B4-induced chemotaxis, ultraviolet-induced erythema). It could be established that dapsone metabolites by their own have anti-inflammatory properties. Pharmacology and mechanisms of action are determining factors for clinical use of dapsone chiefly in neutrophilic and/or eosinophilic dermatoses and in chronic disorders outside the field of dermatology. The steroid-sparing effect of dapsone is useful for numerous clinical entities. Future avenues of investigations will provide more information on this fascinating and essential agent.

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Section: Conclusion For Treating Patients With Dapsonementioning

confidence: 99%

Dapsone in dermatology and beyond

2013

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“…10 The acceptable safety profile of dapsone has been previously reported in several articles. 9,[11][12][13] Several studies have reported that dapsone is an effective drug regardless of previously used treatments. The study by Zaja et al 11 in 20 patients reported a response rate of 55% and a complete response rate of 20%, Damodar et al 13 found a response rate of 61.8% and a complete response rate of 48% in 55 patients, and Colella et al 14 reported a response rate of 66% and a complete response rate of 24% in 122 patients.…”

Section: Discussionmentioning

confidence: 99%

Use of dapsone in chronic/refractory immune thrombocytopenic patients: A single center experience

Candar¹,

Ali²,

Özkalemkaş

et al. 2023

Turkish Journal of Internal Medicine

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Background: Dapsone is a second-line therapy for immune thrombocytopenia (ITP). It is cost-effective, with a response rate comparable to other drugs used as second-line therapy, such as azathioprine, danazol, cyclophosphamide, cyclosporine, vincristine, rituximab, and eltrombopag. Material and Methods: This retrospective study analyzed ten adult patients who presented to our hematology division outpatient clinic between March 2013 and July 2021, was diagnosed with chronic/refractory ITP, did not respond to first-line therapy, and used dapsone. Results: Eight (80%) patients were female, and 2 (20%) were male. The median age was 50 (range, 24-64) years. The mean pre-treatment platelet value was 12.8x109/L (range: 4-22.1x109/L). The median duration of symptoms before dapsone treatment was 60 (6-360) months. The median number of treatments received before dapsone was 4 (range: 3-6). All patients were routinely treated with oral dapsone 50 mg for two weeks, followed by 100 mg. The median time to treatment response was 39 (range: 14-90) days. The response rate was 60% (complete response 40%, partial response 20%). Asymptomatic anemia was observed as a side effect in only one patient. Conclusions: Based on these results, it can be speculated that dapsone is an effective, inexpensive, and well tolerated treatment option. Considering the economic status of developing countries, it seems very attractive to use dapsone as the second-line therapy for chronic/refractory ITP. To the best of our knowledge, this is the first study in Turkey on the use of dapsone for chronic/refractory ITP.

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“…Thereafter, the success of this therapeutic option for treating refractory thrombocytopenia in various conditions, such as ITP, systemic lupus erythematosus, and primary antiphospholipid syndrome, was reported in a string of case reports . In some of these reports, it was successfully used in children, HIV‐positive patients, the elderly, and pregnant women .…”

Section: Reviewmentioning

confidence: 99%

Dapsone for primary immune thrombocytopenia in adults and children: an evidence‐based review

Rodrigo

Gooneratne

2013

Journal of Thrombosis and Haemostasis

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To cite this article: Rodrigo C, Gooneratne L. Dapsone for primary immune thrombocytopenia in adults and children: an evidence-based review. J Thromb Haemost 2013; 11: 1946-53. Summary. Primary immune thrombocytopenia is a potentially life-threatening condition. Approximately two-thirds of adult patients do not have a sustained response to steroids (first-line therapy). For these patients, a number of other treatment options exist, such as rituximab, splenectomy, immunosuppressants, and thrombopoietin receptor agonists, but they are costly and have side effects. Dapsone is an inexpensive drug with a well-established safety profile. Unfortunately, this treatment option has not been explored adequately. This review is aimed at analyzing the currently available evidence for the use of dapsone as second-line or third-line therapy in primary immune thrombocytopenia.

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Dapsone, danazol, and intrapartum splenectomy in refractory ITP complicating pregnancy

Abstract: Currently there is no consensus on the treatment of refractory idiopathic thrombocytopenic purpura (ITP) complicating pregnancy. Our patient with chronic ITP complicating pregnancy, who was refractory to steroids, dapsone, and danazol, was treated successfully with intrapartum splenectomy.

Cited by 9 publications

References 8 publications

Dapsone in dermatology and beyond

Dapsone in dermatology and beyond

Use of dapsone in chronic/refractory immune thrombocytopenic patients: A single center experience

Dapsone for primary immune thrombocytopenia in adults and children: an evidence‐based review

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