Prednisone versus high-dose dexamethasone for untreated primary immune thrombocytopenia. A retrospective study of the Japan Hematology & Oncology Clinical Study Group

Abstract

High-dose dexamethasone (HDD) has been shown to be an effective initial treatment for immune thrombocytopenia (ITP), but it is not clear whether HDD offers any advantages over conventional-dose prednisone (PSL). We retrospectively compared the efficacy and toxicity of HDD and PSL for newly diagnosed ITP. The response was evaluated according to the International Working Group (IWG) criteria. We analyzed data from 31 and 69 patients in the HDD and PSL groups, respectively. There were no significant differences in patient characteristics between the two groups except for the incidence of the eradication of Helicobacter pylori. The response rate was better in the HDD group (42.7 vs. 28.4 %), and this difference was statistically significant when adjusted for other factors including the eradication of H. pylori. In the HDD group, a response was achieved earlier (28 vs. 152 days in median) and steroids were more frequently discontinued at 6 months (64.5 vs. 37.7 %). Among patients who achieved a response, there was no significant difference in the incidence of loss of response. There were no significant differences in the rate of adverse events, transition to chronic ITP, and splenectomy. In conclusion, HDD might enable the early cessation of steroids without a loss of response.

Immune thrombocytopenia: Effectiveness of frontline steroids and comparison of azathioprine, splenectomy, and rituximab as second‐line treatment

“…The ideal dose, regimen, and duration of treatment have not been well established. Several studies showed intermittent high dose dexamethasone treatment is more effective than the conventional, continuous administration of other forms of steroids . Long‐term remission has been reported in a significant number of patients although maintenance treatment was needed in some studies .…”

“…Several studies showed intermittent high dose dexamethasone treatment is more effective than the conventional, continuous administration of other forms of steroids. [15][16][17][18] Long-term remission has been reported in a significant number of patients although maintenance treatment was needed in some studies. 17 Although the present research is not a randomized control study, it consists of a relatively large treatment cohort and, therefore, provides clinical evidence supporting steroids as the standard initial treatment of ITP.…”

High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

“…13 Retrospective studies comparing the 2 approaches in smaller cohorts yielded conflicting results [14][15][16] ; thus, RCTs directly comparing these 2 corticosteroid regimens are required to provide higher level evidence of efficacy. The design of this study was based on the standardized definitions and outcome criteria of the IWG.…”

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

“…There are multiple small trials on prednisone and dexamethasone with various outcomes. [63][64][65][66][67][68][69] In a meta-analysis of high-dose dexamethasone vs prednisone, there was no difference in platelet count response at 6 months; however, high-dose dexamethasone led to faster responses without additional toxicity. 70 Acyclovir may be given with dexamethasone to minimize the potential for herpes virus reactivation (evidence level IV).…”