title: Prednisone versus high-dose dexamethasone for untreated primary immune thrombocytopenia. A retrospective study of the Japan Hematology & Oncology Clinical Study Group.
abstract: High-dose dexamethasone (HDD) has been shown to be an effective initial treatment for immune thrombocytopenia (ITP), but it is not clear whether HDD offers any advantages over conventional-dose prednisone (PSL). We retrospectively compared the efficacy and toxicity of HDD and PSL for newly diagnosed ITP. The response was evaluated according to the International Working Group (IWG) criteria. We analyzed data from 31 and 69 patients in the HDD and PSL groups, respectively. There were no significant differences in patient characteristics between the two groups except for the incidence of the eradication of Helicobacter pylori. The response rate was better in the HDD group (42.7 vs. 28.4 %), and this difference was statistically significant when adjusted for other factors including the eradication of H. pylori. In the HDD group, a response was achieved earlier (28 vs. 152 days in median) and steroids were more frequently discontinued at 6 months (64.5 vs. 37.7 %). Among patients who achieved a response, there was no significant difference in the incidence of loss of response. There were no significant differences in the rate of adverse events, transition to chronic ITP, and splenectomy. In conclusion, HDD might enable the early cessation of steroids without a loss of response.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Tsurumi
authors.forename: Ko
authors.initials: K
authors.lastname: Sasaki
authors.forename: Kinuko
authors.initials: K
authors.lastname: Mitani
authors.forename: Michiko
authors.initials: M
authors.lastname: Kida
authors.forename: Akira
authors.initials: A
authors.lastname: Hangaishi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Usuki
authors.forename: Ayako
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Mariko
authors.initials: M
authors.lastname: Karasawa-Yamaguchi
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okoshi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Chiba
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D016481:Helicobacter Infections / Q000628:therapy; D016480:Helicobacter pylori; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011241:Prednisone