Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone

Yunfeng Cheng, Raymond S.M. Wong, Yannie O.Y. Soo, Chung Hin CHUI, Fung Yi Lau, Natalie P.H. Chan, Wai Shan Wong, Gregory Cheng*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

225 Citations (Scopus)

Abstract

BACKGROUND: The role of high-dose dexamethasone in the treatment of immune thrombocytopenic purpura in adults is controversial. We assessed the effectiveness of high-dose dexamethasone as initial treatment in a series of consecutive adults with immune thrombocytopenic purpura. METHODS: Consecutive patients with newly diagnosed immune thrombocytopenic purpura and a platelet count of less than 20,000 per cubic millimeter or a platelet count of less than 50,000 per cubic millimeter and clinically significant bleeding were enrolled between January 1997 and December 2000. Oral dexamethasone at a dose of 40 mg per day for four consecutive days was the initial treatment. A response was defined as an increase in the platelet count of at least 30,000 per cubic millimeter and a platelet count of more than 50,000 per cubic millimeter by day 10 after the initiation of treatment. A sustained response was defined as a platelet count of more than 50,000 per cubic millimeter six months after the initial treatment. RESULTS: Of 157 consecutive patients, 125 were eligible. The mean (±SD) platelet count before treatment was 12,200±11,300 per cubic millimeter. A good initial response to high-dose dexamethasone occurred in 106 of the 125 patients (85 percent): the platelet count increased by at least 20,000 per cubic millimeter by the third day of treatment, and the mean platelet count was 101,400±53,200 per cubic millimeter (range, 50,000 to 260,000 per cubic millimeter) one week after the initiation of treatment. Among the 106 patients with a response, 53 (50 percent) had a sustained response; the other 53 (50 percent) had a relapse within six months, most of them (94 percent) within the first three months. A platelet count of less than 90,000 per cubic millimeter on day 10 was associated with a high risk of relapse. The treatment was well tolerated. CONCLUSIONS: A four-day course of high-dose dexamethasone is effective initial therapy for adults with immune thrombocytopenic purpura.

Original languageEnglish
Pages (from-to)831-836
Number of pages6
JournalNew England Journal of Medicine
Volume349
Issue number9
DOIs
Publication statusPublished - 28 Aug 2003

Scopus Subject Areas

  • Medicine(all)

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