High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial

Year: 2015

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: This study compared the efficacy and safety of high-dose dexamethasone (HD-DXM) and conventional prednisone (PDN) on the largest cohort to date as first-line strategies for newly diagnosed adult primary immune thrombocytopenia (ITP). Patients enrolled were randomized to receive DXM 40 mg/d for 4 days (n = 95, nonresponders received an additional 4-day course of DXM) or prednisone 1.0 mg/kg daily for 4 weeks and then tapered (n = 97). One or 2 courses of HD-DXM resulted in a higher incidence of overall initial response (82.1% vs 67.4%, P = .044) and complete response (50.5% vs 26.8%, P = .001) compared with prednisone. Time to response was shorter in the HD-DXM arm (P < .001), and a baseline bleeding score ≥8 was associated with a decreased likelihood of initial response. Sustained response was achieved by 40.0% of patients in the HD-DXM arm and 41.2% in the PDN arm (P = .884). Initial complete response was a positive indicator of sustained response, whereas presence of antiplatelet autoantibodies was a negative indicator. HD-DXM was generally tolerated better. We concluded that HD-DXM could be a preferred corticosteroid strategy for first-line management of adult primary ITP. This study is registered at www.clinicaltrials.gov as #NCT01356511.

Source: Blood

DOI: 10.1182/blood-2015-07-659656

Authors: Yu Wei, Xue-bin Ji, Ya-wen Wang, Jing-xia Wang, En-qin Yang, Zheng-cheng Wang, Yu-qi Sang, Zuo-mu Bi, Cui-ai Ren, Fang Zhou, Guo-qiang Liu, Jun Peng, Ming Hou

Institutions: Shandong University, Qilu Hospital of Shandong University, Liaocheng People's Hospital, People’s Hospital of Rizhao, Central Hospital of Zibo, Heze Municipal Hospital, Weifang People's Hospital, Jinan Military General Hospital, Shengli Oilfield Central Hospital

Language: English

Topic: Platelet Disorders and Treatments

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

Funders: Shandong University, National Natural Science Foundation of China, University of Toronto, Natural Science Foundation of Shandong Province, National Public Health Grand Research Foundation, School of Medicine, Stanford University, Science and Technology Development Plan of Shandong Province, Independent Innovation Foundation of Shandong University, Major Research Plan, National High-tech Research and Development Program, National Key Research and Development Program of China

OpenAlex ID: W2179600628