Danazol for the treatment of refractory autoimmune thrombocytopenia in systemic lupus erythematosus.
OBJECTIVE
to determine the efficacy of danazol therapy in patients with systemic lupus erythematosus with severe autoimmune thrombocytopenia refractory to other therapies.


METHODS
noncontrolled clinical trial, with a minimum of 8 weeks of therapy, the maximum determined by clinical response.


METHODS
referral-based rheumatology clinic at an army medical center.


METHODS
sequential sample of six patients with systemic lupus erythematosus with severe autoimmune thrombocytopenia refractory to high-dose glucocorticoids. Four patients also failed splenectomy, or cytotoxic drugs, or both.


METHODS
danazol, 200 mg four times per day, was added to the previous therapeutic regimen for at least 2 months.


RESULTS
all six patients had normal platelet counts within 6 weeks of starting danazol treatment. After resolution of thrombocytopenia for at least 1 month, immunosuppressive medications were tapered; one patient had a relapse. During an average follow-up of 12 months, the danazol dose was lowered in the five remaining patients but could not be discontinued without recurrence of thrombocytopenia. During danazol therapy, platelet-bound IgG antibodies and circulating immune complexes did not decrease significantly. Danazol was well tolerated.


CONCLUSIONS
danazol appears to be a useful adjunctive treatment for refractory autoimmune thrombocytopenia associated with systemic lupus erythematosus.
West
S G
SG
Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado.
Johnson
S C
SC
D000328:Adult; D000368:Aged; D000936:Antigen-Antibody Complex / Q000378:metabolism; D001327:Autoimmune Diseases / Q000188:drug therapy* / Q000209:etiology; D001379:Azathioprine / Q000627:therapeutic use; D001792:Blood Platelets / Q000276:immunology; D003131:Combined Modality Therapy; D003613:Danazol / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000378:metabolism; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011245:Pregnadienes / Q000627:therapeutic use*; D013156:Splenectomy; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology
D000936:Antigen-Antibody Complex; D005938:Glucocorticoids; D007074:Immunoglobulin G; D011245:Pregnadienes; D001379:Azathioprine; D003613:Danazol