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High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura: a randomized study

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Abstract

Therapeutic plasma exchange (PE) is the accepted therapy for thrombotic thrombocytopenic purpura (TTP). Because not all patients achieve remission, other treatment modalities have been used in addition to PE, but no randomized clinical trial evaluated their efficacy. The aim of this multicentric study was to compare the effectiveness of standard- versus high-dose methylprednisolone as an adjunctive treatment to PE in the acute phase of TTP. Sixty patients with idiopathic TTP were randomized to receive methylprednisolone 1 mg/kg/die intravenous or 10 mg/kg/die for 3 days, thereafter, 2.5 mg/kg/die in addition to PE. Both dosages of steroids were well tolerated. At the end of induction therapy (day 23), the percentage of patients failing to achieve complete remission was significantly higher in the standard dose (16 of 30) than in the high-dose group (seven of 30). Also, the number of cases without a good response at day 9 and the number of deaths were higher in the standard-dose arm, but the differences did not reach the statistical significance. Results of present study indicate that the association of PE with high-dose instead of standard-dose steroids reduces the percentage of TTP patients that fail to achieve complete remission.

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Authors and Affiliations

  1. Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy

    Carlo L. Balduini, Carla Pieresca, Gianluca Casella, Patrizia Noris & Edoardo Ascari

  2. Haematology, Santa Maria Nuova Hospital, Reggio Emilia, Italy

    Luigi Gugliotta

  3. Haematology, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy

    Mario Luppi

  4. Haematology, Catholic University, A. Gemelli Hospital, Rome, Italy

    Luca Laurenti

  5. Biometry and Clinical Epidemiology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy

    Catherine Klersy

  6. Haematology-BMT, Paolo Giaccone Hospital, Palermo, Italy

    Gerlando Quintini

  7. Haematology, Giannettasio Hospital, Rossano Calabro, Italy

    Francesco Iuliano

  8. Unit of Medicine, Civitanova Marche Hospital, Civitanova Marche, Italy

    Rossana Re

  9. Haematology and BMT, Cremona Hospital, Cremona, Italy

    Pierangelo Spedini

  10. Hematology and Oncology, L. and A. Seràgnoli Hospital, University of Bologna, Bologna, Italy

    Nicola Vianelli

  11. Oncology, Ravenna Hospital, Ravenna, Italy

    Alfonso Zaccaria

  12. Haematology-BMT, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy

    Enrico Maria Pogliani

  13. Haematology, Ferrarotto University Hospital, Catania, Italy

    Roberto Musso

  14. Haematology and Oncology, Crema Hospital, Crema, Italy

    Enrico Bobbio Pallavicini

  15. Haematology, A. Perrino Hospital, Brindisi, Italy

    Giovanni Quarta

  16. Haematology, Mazzoni Hospital, Ascoli Piceno, Italy

    Piero Galieni

  17. Internal Medicine, Madonna delle Grazie Hospital, Matera, Italy

    Alberto Fragasso

  18. Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, Piazzale Golgi, 27100, Pavia, Italy

    Carlo L. Balduini

Authors
  1. Carlo L. Balduini
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  2. Luigi Gugliotta
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  3. Mario Luppi
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  4. Luca Laurenti
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  5. Catherine Klersy
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  6. Carla Pieresca
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  7. Gerlando Quintini
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  8. Francesco Iuliano
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  9. Rossana Re
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  10. Pierangelo Spedini
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  14. Roberto Musso
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  15. Enrico Bobbio Pallavicini
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  16. Giovanni Quarta
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  17. Piero Galieni
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  18. Alberto Fragasso
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  19. Gianluca Casella
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  20. Patrizia Noris
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  21. Edoardo Ascari
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Consortia

The Italian TTP Study Group

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Correspondence to Carlo L. Balduini.

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Balduini, C.L., Gugliotta, L., Luppi, M. et al. High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura: a randomized study. Ann Hematol 89, 591–596 (2010). https://doi.org/10.1007/s00277-009-0877-5

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  • DOI: https://doi.org/10.1007/s00277-009-0877-5

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