title: High doses of dexamethasone in adult patients with idiopathic thrombocytopenic purpura.
abstract: BACKGROUND
  High-dose dexamethasone (DXM) has been used in treatment of patients with idiopathic thrombocytopenic purpura (ITP) who are refractory to other treatments such as prednisone and splenectomy; nevertheless, different studies show variable success rates, this postulated as possibly being due to racial differences. The objective of this study was to determine DXM effectiveness at high doses in Mexican mestizo adult patients diagnosed with ITP with and without splenectomy.
  
  
  METHODS
  Nonhospitalized adult patients with ITP were included, eight patients previously splenectomized (group 1) and 11 who had not undergone splenectomy (group 2). Patients received DXM 40 mg/day intravenously (i.v.) during 4 consecutive days every 4 weeks until six cycles were completed.
  
  
  RESULTS
  There were no differences between the two groups regarding age (mean 39 vs. 33 years of age) and initial platelet count (M 17 vs. 24 x 10(9)/L). Median evolution time was 84 months for group 1 and 7 months for group 2 (p = 0.002). Of 19 patients, nine achieved a favorable response (FR), six belonged to group 1, and three to group 2 (Fisher p = 0.07). Nevertheless, after 6 months only two group 1 patients and two group 2 patients maintained FR (Fisher exact test p = 1). Patients achieving FR to initiation of second cycle maintained FR at the end of six cycles.
  
  
  CONCLUSIONS
  Thus, the previously mentioned high-dose DXM therapy appears to be useful for both patients with ITP with and without splenectomy and high-dose DXM appears to be a good alternative therapy for postsplenectomy and relapse patients. However, duration of FR to treatment was brief; therefore, other treatment plans might be required to achieve longer remission duration. Response was similar to that observed in other studies carried out in different populations; thus, apparently no genetic or racial variations exist. In addition, whether patients not responding after second cycle should continue until completing the 6-month plan or should try a different therapeutic approach must be considered in the treatment plan.
authors.affiliation: Servicio de Hematología, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. gmogutes@hotmail.com
authors.forename: Guillermo R
authors.initials: GR
authors.lastname: Gutiérrez-Espíndola
authors.forename: Manuel R
authors.initials: MR
authors.lastname: Morales-Polanco
authors.forename: Susana
authors.initials: S
authors.lastname: Guerrero-Rivera
authors.forename: Juan O
authors.initials: JO
authors.lastname: Talavera
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sánchez-Valle
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Morales
authors.forename: Javier
authors.initials: J
authors.lastname: Pizzuto-Chávez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D013156:Splenectomy
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone