High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults.
The current first-line choice of treatment of idiopathic thrombocytopenic purpura (ITP) in adults, prednisone, is effective but has many side effects. Furthermore, reduction of the dose leads to a relapse of ITP in a majority of cases. Courses of high-dose dexamethasone (HD) aim to avoid these problems. We treated 36 patients with newly diagnosed or recurrent ITP with an 8-day course of HD, with a peak dose of 40 mg/day. The courses were repeated up to a maximum of six courses, with a 28-day interval. Acute and chronic effects of HD on platelet counts were observed, as well as side effects. HD led to an acute response (rise of platelet count to a level above 50 x 10(9)/l) in 83%. When HD was given as a first-line treatment, 59% of patients were still in remission after 31 months. When HD was given as a second-line treatment, 50% of patients were in remission after 5 months, declining to 25% after 54 months. Side effects were frequent but rarely dangerous. In conclusion, acute effects of HD were excellent. Long-term effects of HD as a first-line therapy of ITP were good, but its long-term effects as a second-line therapy were much poorer.
Department of Nephrology, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands. filipborst@hotmail.com
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F
Borst
J J
JJ
Keuning
H
H
van Hulsteijn
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H
Sinnige
G
G
Vreugdenhil
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction
D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone