High-dose cycles of dexamethasone in idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura (ITP) in adults is usually treated with standard therapy using prednisone or methylprednisolone, adding intravenous immunoglobulin or Anti-D if necessary. This first episode of therapy frequently results in an early and satisfactory response, but remission is often temporary. As a series of relapses occur, or chronic low platelet counts persist, decisions on additional or alternative therapy are considered (i.e. splenectomy, chemotherapy).

High-dose dexamethasone in 4-day cycles (HD) has been used with some success reported in small numbers of patients with ITP. This retrospective analysis using HD in patients with ITP compared with standard therapy reports our experience at a large teaching hospital, comparing the timing and results of 26 episodes of treatment in 6 patients with no other underlying disease or complications.

The six patients had nine Adequate Responses (AR's >100,000 platelets) in the 13 episodes using HD, and HD was successful in later episodes, 4th-7th. There were seven AR's in the 13 episodes using prednisone or methylprednisolone treatment. The time to remission and interval to relapse were similar after either intervention.

This report of six patients with 26 episodes of treatment with standard therapy or HD provides additional data on HD as a useful alternative in patients with ITP, especially later in sequential relapses. The follow-up time in this group of patients is not sufficient to determine if modulation of the autoimmune process was achieved. Whether use of corticosteroids in repeated cycles, variation in doses, the timing, or the mechanism of action makes a difference in these autoimmune disorders remains to be established.