Annals of Hematology

, Volume 89, Issue 6, pp 591–596

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

  • Carlo L. Balduini
  • Luigi Gugliotta
  • Mario Luppi
  • Luca Laurenti
  • Catherine Klersy
  • Carla Pieresca
  • Gerlando Quintini
  • Francesco Iuliano
  • Rossana Re
  • Pierangelo Spedini
  • Nicola Vianelli
  • Alfonso Zaccaria
  • Enrico Maria Pogliani
  • Roberto Musso
  • Enrico Bobbio Pallavicini
  • Giovanni Quarta
  • Piero Galieni
  • Alberto Fragasso
  • Gianluca Casella
  • Patrizia Noris
  • Edoardo Ascari
  • The Italian TTP Study Group
Original Article

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.

Keywords

TTP Steroids Plasma exchange Thrombocytopenia 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Carlo L. Balduini
    • 1
    • 18
  • Luigi Gugliotta
    • 2
  • Mario Luppi
    • 3
  • Luca Laurenti
    • 4
  • Catherine Klersy
    • 5
  • Carla Pieresca
    • 1
  • Gerlando Quintini
    • 6
  • Francesco Iuliano
    • 7
  • Rossana Re
    • 8
  • Pierangelo Spedini
    • 9
  • Nicola Vianelli
    • 10
  • Alfonso Zaccaria
    • 11
  • Enrico Maria Pogliani
    • 12
  • Roberto Musso
    • 13
  • Enrico Bobbio Pallavicini
    • 14
  • Giovanni Quarta
    • 15
  • Piero Galieni
    • 16
  • Alberto Fragasso
    • 17
  • Gianluca Casella
    • 1
  • Patrizia Noris
    • 1
  • Edoardo Ascari
    • 1
  • The Italian TTP Study Group
  1. 1.Internal Medicine, IRCCS Policlinico San Matteo FoundationUniversity of PaviaPaviaItaly
  2. 2.HaematologySanta Maria Nuova HospitalReggio EmiliaItaly
  3. 3.Haematology, Department of Oncology, Haematology and Respiratory DiseasesUniversity of Modena and Reggio EmiliaModenaItaly
  4. 4.Haematology, Catholic UniversityA. Gemelli HospitalRomeItaly
  5. 5.Biometry and Clinical EpidemiologyIRCCS Policlinico San Matteo FoundationPaviaItaly
  6. 6.Haematology-BMTPaolo Giaccone HospitalPalermoItaly
  7. 7.HaematologyGiannettasio HospitalRossano CalabroItaly
  8. 8.Unit of MedicineCivitanova Marche HospitalCivitanova MarcheItaly
  9. 9.Haematology and BMTCremona HospitalCremonaItaly
  10. 10.Hematology and OncologyL. and A. Seràgnoli Hospital, University of BolognaBolognaItaly
  11. 11.OncologyRavenna HospitalRavennaItaly
  12. 12.Haematology-BMT, San Gerardo HospitalUniversity of Milano BicoccaMonzaItaly
  13. 13.HaematologyFerrarotto University HospitalCataniaItaly
  14. 14.Haematology and OncologyCrema HospitalCremaItaly
  15. 15.HaematologyA. Perrino HospitalBrindisiItaly
  16. 16.HaematologyMazzoni HospitalAscoli PicenoItaly
  17. 17.Internal MedicineMadonna delle Grazie HospitalMateraItaly
  18. 18.Department of Internal MedicineIRCCS Policlinico San Matteo FoundationPaviaItaly

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