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Blood. 2016 Jan 21;127(3):296-302; quiz 370. doi: 10.1182/blood-2015-07-659656. Epub 2015 Oct 19.

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

Author information

1
Department of Hematology, Qilu Hospital, Shandong University, Jinan, China;
2
Department of Hematology, Liaocheng People's Hospital, Liaocheng, China;
3
Department of Hematology, People's Hospital of Rizhao, Rizhao, China;
4
Department of Hematology, Central Hospital of Zibo, Zibo, China;
5
Department of Hematology, Heze Municipal Hospital, Heze, China;
6
Department of Hematology, Zibo First Hospital, Zibo, China;
7
Department of Hematology, Weifang People's Hospital, Weifang, China;
8
Department of Hematology, Jinan Military General Hospital, Jinan, China;
9
Department of Hematology, Shengli Oilfield General Hospital, Dongying, China;
10
Department of Hematology, Qilu Hospital, Shandong University, Jinan, China; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital, Shandong University, Jinan, China; and.
11
Department of Hematology, Qilu Hospital, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Shandong University, Jinan, China.

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.

Comment in

PMID:
26480931
DOI:
10.1182/blood-2015-07-659656
[Indexed for MEDLINE]

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