title: Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura.
abstract: In adults with immune thrombocytopenic purpura (ITP), steroids are usually proposed as first-line therapy, but long-term complete responses are obtained in no more than 20% of patients. For the remaining patients, splenectomy is considered the treatment of choice, with reported "cure" rates from 60-70%. However, the inherent risks of surgery and sepsis after splenectomy without a guarantee of success justify the search for strategies aimed to avoid splenectomy. Here we retrospectively evaluated the results of dapsone treatment in ITP patients that failed first-line therapy with steroids. These patients received dapsone 100 mg/day for a minimum of 30 days before splenectomy was considered. Efficacy was defined as a sustained rise in platelet counts (>50 x 10(9)/l) clearly attributed to dapsone treatment. Among 52 steroid-dependent or refractory patients, dapsone resulted in sustained increases in platelet counts in 44.2% of patients, after a median follow-up of 21.10 months after treatment initiation. The long-term efficacy of dapsone in this setting is further corroborated by the observation that none of the "responding" patients required splenectomy in the follow-up, compared to 69.0% of the "non-responding" patients. Dapsone-related adverse events were mild and promptly reversed by treatment withdrawal. The results of our retrospective analysis suggest that dapsone is a safe and effective second-line agent for steroid-dependent or refractory ITP patients. Because of its well-known safety profile and low cost compared to other potential second-line treatments for ITP, a trial course of dapsone should be viewed as an attractive option before splenectomy in steroid-dependent of refractory adult ITP patients.
authors.affiliation: Hematology and Hemotherapy Center, State University of Campinas, Campinas, SP, Brazil.
authors.forename: Suley Mara Chaddad
authors.initials: SM
authors.lastname: Vancine-Califani
authors.forename: Erich Vinicius
authors.initials: EV
authors.lastname: De Paula
authors.forename: Margareth Castro
authors.initials: MC
authors.lastname: Ozelo
authors.forename: Fernanda Loureiro Andrade
authors.initials: FL
authors.lastname: Orsi
authors.forename: Daniela Ramos
authors.initials: DR
authors.lastname: Fabri
authors.forename: Joyce Maria
authors.initials: JM
authors.lastname: Annichino-Bizzacchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003622:Dapsone / Q000627:therapeutic use* / Q000633:toxicity; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003622:Dapsone