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High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults

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Abstract

The current first-line choice of treatment of idiopathic thrombocytopenic purpura (ITP) in adults, prednisone, is effective but has many side effects. Furthermore, reduction of the dose leads to a relapse of ITP in a majority of cases. Courses of high-dose dexamethasone (HD) aim to avoid these problems. We treated 36 patients with newly diagnosed or recurrent ITP with an 8-day course of HD, with a peak dose of 40 mg/day. The courses were repeated up to a maximum of six courses, with a 28-day interval. Acute and chronic effects of HD on platelet counts were observed, as well as side effects. HD led to an acute response (rise of platelet count to a level above 50×109/l) in 83%. When HD was given as a first-line treatment, 59% of patients were still in remission after 31 months. When HD was given as a second-line treatment, 50% of patients were in remission after 5 months, declining to 25% after 54 months. Side effects were frequent but rarely dangerous. In conclusion, acute effects of HD were excellent. Long-term effects of HD as a first-line therapy of ITP were good, but its long-term effects as a second-line therapy were much poorer.

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Acknowledgements

We are highly indebted to W.P. Breed, C.M.P.W. Mandigers, E.J.M. Mattijssen, A.W. Mulder, M. Oosterveld, W.G. Peters, J.M.J.I. Salemans, A.V.M.B. Schattenberg, R.E.H. Smeets, W. Verheul, A.G. Weenink, T.J.M. de Witte and A.A.C. Wolff for including patients in our study.

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Authors and Affiliations

  1. Department of Nephrology, University Medical Centre St Radboud, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    F. Borst

  2. Department. of Internal Medicine, Maxima Medical Centre, PO Box 7777, 6500 MB, Veldhoven, The Netherlands

    J. J. Keuning & G. Vreugdenhil

  3. Bernhoven Hospital, PO Box 10000, 5460 DA, Veghel, The Netherlands

    H. van Hulsteijn

  4. Jeroen Bosch Hospital, PO Box 90153, 5200 ME, ‘s Hertogenbosch, The Netherlands

    H. Sinnige

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  1. F. Borst
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  2. J. J. Keuning
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  3. H. van Hulsteijn
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  4. H. Sinnige
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  5. G. Vreugdenhil
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Correspondence to F. Borst.

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Borst, F., Keuning, J.J., van Hulsteijn, H. et al. High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults. Ann Hematol 83, 764–768 (2004). https://doi.org/10.1007/s00277-004-0908-1

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  • DOI: https://doi.org/10.1007/s00277-004-0908-1

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