Immunosuppressive therapy of chronic idiopathic thrombocytopenic purpura

Finch, Stuart C.; Castro, Oswaldo; Cooper, Milton; Covey, William D.; Erichson, Robert B.; McPhedran, Peter

doi:10.1016/0002-9343(74)90745-1

Cited by 69 publications

(29 citation statements)

References 19 publications

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“…[17][18][19][20] All reported studies evaluating the ef cacy of prednisone, danazol and cytotoxic drugs in the treatment of autoimmune hemocytopenia associated with SLE are case series and they report mainly short-term effects. [7][8][9][10][11][12][13][14] Moreover, comparisons among several drugs in the same set of patients have not been reported. Therefore, to our knowledge, this report is the rst and the largest study comparing the long-term effectiveness of prednisone, danazol and cytotoxic drugs in autoimmune hemocytopenia secondary to SLE in the same setting of patients.…”

Section: Discussionmentioning

confidence: 99%

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Long-term effectiveness of danazol corticosteroids and cytotoxic drugs in the treatment of hematologic manifestations of systemic lupus erythematosus

Galindo-Rodrìguez²,

Robledo³

et al. 2003

Lupus

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The purpose of this study was to compare the long-term effectiveness among danazol, corticosteroids, cytotoxics, and dapsone in the treatment of hematological manifestations of systemic lupus erythematosus (SLE). Medical charts of all patients seen at the Rheumatic Disease Unit from January to December of 1998 were reviewed. Patient characteristics, disease and treatment information were collected. The main outcome measures were the cause of and time to discontinuation of drugs used to treat hematological manifestations of SLE resulting from all causes, mainly toxicity and inefficacy or both. Bivariate analysis including one-way ANOVA and chi2 tests were used to compare differences between means and proportions, respectively. Survival curves among the different drugs were evaluated using the Kaplan-Meier method. Multivariate analysis (Cox-regression) was used to adjust for potential confounders. After all medical records were reviewed 41 cases were eligible. Two cases had hemolytic anemia, 34 had thrombocytopenia, and five had both. These cases had received a total of 121 cycles of treatment at different times and they represent the study population (corticosteroids n = 37, danazol n = 51, citotoxic drugs n = 29, and dapsone n = 4). Crude rates of discontinuations due to any cause, toxicity and inefficacy werenot statistically significant among the drugs. However, the Kaplan-Meier curves showed statistically significant difference for discontinuations due to all causes as well as inefficacy. Prednisone and cytotoxic drugs had the lowest probability of continuation. In contrast, there were not statistically significant differences among the drugs with respect to first relapse. This is the first study examining the long-term termination rates of several drugs used to treat hematological manifestations of SLE. Using rates of discontinuation adjusted for time there were statistically significant differences among the drugs. Danazol had the highest probability of continuation.

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Section: Discussionmentioning

confidence: 99%

“…13,14 Several studies have evaluated the ef cacy of danazol, corticosteroids, cytotoxic drugs in the management of thrombocytopenia as well as hemolytic anemia in SLE. [7][8][9][10][11][12]15 Most of these studies are case series and evaluated short term ef cacy of a single drug.…”

Section: Introductionmentioning

confidence: 99%

Long-term effectiveness of danazol corticosteroids and cytotoxic drugs in the treatment of hematologic manifestations of systemic lupus erythematosus

Galindo-Rodrìguez²,

Robledo³

et al. 2003

Lupus

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“…Immunosuppressants are generally re served for those patients who failed to re spond to steroids and splenectomy [9]. In particular, VCR has been claimed to be the treatment of choice for patients with ITP re fractory to steroids and splenectomy [1, 17, 18J, but neurotoxicity has proved to be a se rious limiting factor.…”

Section: Discussionmentioning

confidence: 99%

Infusion of Vincristine-Loaded Platelets in Acute ITP Refractory to Steroids: An Alternative to Splenectomy

et al. 1981

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Three infusions of vincristine-loaded platelets were carried out in a young man with acute idiopathic thrombocytopenic purpura (ITP) refractory to steroids. This procedure, used until now only for chronic refractory ITP, insured a remission without side effects. After 2 years of follow-up the patient has not had relapse. A potentially dangerous splenectomy was thus avoided in a phase of the disease in which a spontaneous remission was still very probable.

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“…Azathioprine is used in daily dosages of 50-150 mg per SMBS and is given for a minimum of 3 months [10,20,44]. Up to 26 months of therapy is required before the platelet count is stabilized.…”

Section: Older Nonsteriodal Immunosuppressantsmentioning

confidence: 99%