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PULSED STEROIDS FOR ITP.

Some patients with idiopathic thrombocytopenic purpura (ITP) relapse after an initial response to first-line therapy (daily corticosteroids or splenectomy), and most second-line therapies are plagued by toxicity, cost, or suboptimal efficacy. This study examined the efficacy of "pulsed" intermittent dexamethasone, a well-tolerated and inexpensive corticosteroid.

Researchers administered a 6-month course of "pulsed" dexamethasone (40 mg daily for 4 days each month) to 10 patients with refractory ITP (mean platelet count, 12,000/cubic millimeter). Prior to this intervention, each patient had received at least one conventional course of daily prednisone, and at least one alternative treatment (such as splenectomy, danazol, vincristine, or immune globulin) during 18 to 84 months of the disease.

All 10 patients had striking responses; six months after completing pulsed dexamethasone all patients had platelet counts above 100,000, and the six patients followed for one year remained above this level. There were no serious side effects.

Comment: Although the study was uncontrolled, it is reasonable to conclude that these patients responded to pulsed dexamethasone. Before this regimen becomes a standard treatment for ITP, replication of results by other investigators and longer follow-up are essential.

— AS Brett

Published in Journal Watch General Medicine June 14, 1994

Citation(s):

Andersen JC. Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994 Jun 2 330 1560-1564.

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