Pulsed high-dose dexamethasone in resistant immune thrombocytopenic purpura
Bulvik, S.; Ben-Tal, O.; Shimoni, Z.; Eldor, A.
Harefuah 131(1-2): 18-20 71
1996
ISSN/ISBN: 0017-7768 PMID: 8854471 Document Number: 1161
Most patients with chronic idiopathic thrombocytopenic purpura (ITP) show a good initial response to treatment with corticosteroids. However the disease relapses in more than 90% when steroid dosage is reduced. Recently 100% success was reported for a new therapeutic protocol in 12 patients (ranging in age from 13-60, half of them women) with chronic ITP refractory to corticosteroids or to splenectomy. They were given pulsed therapy with oral dexamethasone, 40 mg/day on 4 consecutive days each month, for 6 months. This treatment protocol was used in an attempt to avoid splenectomy. 5 patients (42%) had a complete response but 7 did not. The median follow-up in those who responded was 7 months (range 6-8). Of the 7 who did not respond, 5 had not completed treatment: 3 because of urgent splenectomy and 2 because of lack of response after 3 courses of therapy accompanied by side-effects. Most patients suffered typical corticosteroid side-effects, principally restlessness, insomnia, and withdrawal effects. These were milder and better tolerated in those treated with Dexacort solution (20 mg ampules) rather than dexamethasone tablets. Despite complete response in only 5 of the 12 patients (42%), we feel that pulsed high-dose dexamethasone is effective and should be tried in ITP refractory to conventional corticosteroid therapy, before resorting to splenectomy.
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