Long-term danazol therapy in autoimmune thrombocytopenia: unmaintained remission and age-dependent response in women.
OBJECTIVE
To assess the long-term benefit and side effects of danazol therapy, and to delineate factors influencing the responses in patients with autoimmune thrombocytopenia.


METHODS
Before and after trial.


METHODS
Referral-based hematology clinics and the University of Miami teaching hospitals.


METHODS
Data were collected on 96 patients (60 women and 36 men, 45 of whom had had splenectomies) receiving danazol therapy for autoimmune thrombocytopenia and analyzed.


METHODS
Danazol was added to the previous therapy or begun as an initial therapy. Glucocorticoids were tapered gradually.


RESULTS
The overall response rate to danazol was 61.4%. Among responders, the platelet counts (mean +/- SD) before and after danazol treatment were 36 +/- 24 x 10(9)/L and 145 +/- 77 x 10(9)/L, respectively, and the time to response was 2.7 +/- 3 months. Sex, age, and the status of the spleen (absent or present) influenced the responses to danazol. In women, but not in men, response rates improved with advancing age, especially in the nonsplenectomized women. This may be because estrogen levels are high in younger women and low in older women and men. Danazol, when given longer than a year, induced remissions lasting for years even after its discontinuation, but early relapses were frequent when danazol was administered for less than 6 months. Platelet-associated IgG returned to normal range during unmaintained remission.


CONCLUSIONS
Danazol is best suited for long-term medical management of autoimmune thrombocytopenia. It is well tolerated, and lasting, unmaintained remissions often occur after prolonged danazol administration. Age, sex, and the status of the spleen influence the responses. When danazol therapy is used, glucocorticoids can be substantially reduced in dosage or withdrawn. Danazol is a good alternative to splenectomy in elderly persons, especially in women.
Ahn
Y S
YS
University of Miami Hospital, Florida.
Rocha
R
R
Mylvaganam
R
R
Garcia
R
R
Duncan
R
R
Harrington
W J
WJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000188:drug therapy*; D001792:Blood Platelets / Q000276:immunology; D003613:Danazol / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011245:Pregnadienes / Q000627:therapeutic use*; D011696:Purpura, Thrombocytopenic / Q000188:drug therapy* / Q000276:immunology; D012074:Remission Induction; D012737:Sex Factors; D013156:Splenectomy; D013223:Statistics as Topic; D013997:Time Factors
D005938:Glucocorticoids; D007074:Immunoglobulin G; D011245:Pregnadienes; D003613:Danazol