FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 349:831-836 August 28, 2003 Number 9 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by George, J. N. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The role of high-dose dexamethasone in the treatment of immune thrombocytopenic purpura in adults is controversial. We assessed the effectiveness of high-dose dexamethasone as initial treatment in a series of consecutive adults with immune thrombocytopenic purpura.

Methods Consecutive patients with newly diagnosed immune thrombocytopenic purpura and a platelet count of less than 20,000 per cubic millimeter or a platelet count of less than 50,000 per cubic millimeter and clinically significant bleeding were enrolled between January 1997 and December 2000. Oral dexamethasone at a dose of 40 mg per day for four consecutive days was the initial treatment. A response was defined as an increase in the platelet count of at least 30,000 per cubic millimeter and a platelet count of more than 50,000 per cubic millimeter by day 10 after the initiation of treatment. A sustained response was defined as a platelet count of more than 50,000 per cubic millimeter six months after the initial treatment.

Results Of 157 consecutive patients, 125 were eligible. The mean (±SD) platelet count before treatment was 12,200±11,300 per cubic millimeter. A good initial response to high-dose dexamethasone occurred in 106 of the 125 patients (85 percent): the platelet count increased by at least 20,000 per cubic millimeter by the third day of treatment, and the mean platelet count was 101,400±53,200 per cubic millimeter (range, 50,000 to 260,000 per cubic millimeter) one week after the initiation of treatment. Among the 106 patients with a response, 53 (50 percent) had a sustained response; the other 53 (50 percent) had a relapse within six months, most of them (94 percent) within the first three months. A platelet count of less than 90,000 per cubic millimeter on day 10 was associated with a high risk of relapse. The treatment was well tolerated.

Conclusions A four-day course of high-dose dexamethasone is effective initial therapy for adults with immune thrombocytopenic purpura.

Source Information

From the Departments of Medicine and Therapeutics (Y.C., R.S.M.W., Y.O.Y.S., F.Y.L., G.C.) and Anatomical and Cellular Pathology (N.P.H.C., W.S.W.), Chinese University of Hong Kong; and the Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University (C.H.C.) — both in Hong Kong.

Address reprint requests to Dr. Gregory Cheng at the Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Ngan Shing St., Shatin NT, Hong Kong, or at gcheng{at}cuhk.edu.hk.

Full Text of this Article

Related Letters:

High-Dose Dexamethasone as Initial Treatment for Immune Thrombocytopenic Purpura
Godeau B., Bierling P., Wong R. S.M., Soo Y. O.Y., Cheng G.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:2267-2268, Dec 4, 2003. Correspondence

This article has been cited by other articles:

• Shan, N.-n., Zhu, X.-j., Wang, Q., Wang, C.-y., Qin, P., Peng, J., Hou, M. (2009). High-dose dexamethasone regulates interleukin-18 and interleukin-18 binding protein in idiopathic thrombocytopenic purpura. haematol 94: 1603-1607 [Abstract] [Full Text]  
• George, J. N. (2009). Definition, diagnosis and treatment of immune thrombocytopenic purpura. haematol 94: 759-762 [Full Text]  
• Bussel, J. B., Kuter, D. J., Pullarkat, V., Lyons, R. M., Guo, M., Nichol, J. L. (2009). Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood 113: 2161-2171 [Abstract] [Full Text]  
• Zhao, C., Li, X., Zhang, F., Wang, L., Peng, J., Hou, M. (2008). Increased cytotoxic T-lymphocyte-mediated cytotoxicity predominant in patients with idiopathic thrombocytopenic purpura without platelet autoantibodies. haematol 93: 1428-1430 [Full Text]  
• Ruggeri, M., Fortuna, S., Rodeghiero, F. (2008). Heterogeneity of terminology and clinical definitions in adult idiopathic thrombocytopenic purpura: a critical appraisal from a systematic review of the literature. haematol 93: 98-103 [Abstract] [Full Text]  
• Cines, D. B. (2007). Pumping out platelets. Blood 109: 4591-4592 [Full Text]  
• Mazzucconi, M. G., Fazi, P., Bernasconi, S., De Rossi, G., Leone, G., Gugliotta, L., Vianelli, N., Avvisati, G., Rodeghiero, F., Amendola, A., Baronci, C., Carbone, C., Quattrin, S., Fioritoni, G., D'Alfonso, G., Mandelli, F., for the Gruppo Italiano Malattie EMatologiche dell, (2007). Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood 109: 1401-1407 [Abstract] [Full Text]  
• Cines, D. B., Bussel, J. B. (2005). How I treat idiopathic thrombocytopenic purpura (ITP). Blood 106: 2244-2251 [Full Text]  
• Stasi, R., Provan, D. (2004). Management of Immune Thrombocytopenic Purpura in Adults. Mayo Clin Proc. 79: 504-522 [Abstract]  
• Godeau, B., Bierling, P., Wong, R. S.M., Soo, Y. O.Y., Cheng, G. (2003). High-Dose Dexamethasone as Initial Treatment for Immune Thrombocytopenic Purpura. NEJM 349: 2267-2268 [Full Text]  
• (2003). Short-Course, High-Dose Steroids for ITP. JWatch General 2003: 1-1 [Full Text]  
• George, J. N., Vesely, S. K. (2003). Immune Thrombocytopenic Purpura -- Let the Treatment Fit the Patient. NEJM 349: 903-905 [Full Text]