comparison of high-dose dexamethasone and prednisone for initial treatment of adult primary immune thrombocytopenia比较高剂量地塞米松和强的松的初始治疗成人原发性免疫的血小板减少症.pdfVIP

Open Journal of Blood Diseases, 2012, 85-89 85 /10.4236/ojbd.2012.24016 Published Online December 2012 (http://www.SciRP.org/journal/ojbd) Comparison of High-Dose Dexamethasone and Prednisone for Initial Treatment of Adult Primary Immune Thrombocytopenia Masanao Teramura, Midori Ishiyama, Hiroshi Kazama, Kentaro Yoshinaga, Masayuki Shiseki, Naoki Mori, Toshiko Motoji Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan. Email: teramura@dh.twmu.ac.jp Received October 14th, 2012; revised November 18th, 2012; accepted November 30th, 2012 ABSTRACT Prednisone is the most common first-line treatment for adult primary immune thrombocytopenia (ITP). However, the best initial therapeutic approach is still a matter of debate. Prior studies have shown that high-dose dexamethasone (HD-DXM) produces a high sustained efficacy not achieved by conventional prednisone therapy. However, the defini- tion of response widely differs between individual reports, and this heterogeneity makes comparison of the efficacy difficult. The aim of our study was to compare the therapeutic outcomes of a conventional dose of prednisone with HD-DXM for adult ITP patients as initial therapy. Thirty patients treated with prednisone and 22 patients treated HD-DXM were retrospectively analyzed. No significant differences between the HD-DXM and prednisone groups were observed for the rates of complete response (68% vs. 70%) and response (18% vs. 17%). However, 1 year probability of sustained response was significantly greater in the HD-DXM group than in the prednisone group (78% vs. 38%; P = 0.008). No adverse events necessitating discontinuation of treatment were observed in either group. Our retrospective analysis showed that initial treatment with HD-DXM prod