Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia

In a randomized prospective study, sixty adult patients with newly diagnosed primary symptomatic ITP (Platelet count？<？20,000) were evaluated. Patients divided into two groups. In group A, thirty patients (mean age of 24.9 years) received Dexamethasone 40 mg/IV/daily for four days (10 mg/q6h); and then Prednisolone 1 mg/kg/day/PO with rapid tapering of prednisolone (10 mg/week). From the other hand, in group B, thirty patients (mean age of 27.2 years) were treated with Prednisolone 1 mg/kg/day/PO for four weeks, then the drug tapered weekly.All the patients in group A showed favorable response within the first seven days, 27 cases presented complete response (CR) and three cases revealed response (R). In group B, 11 cases had CR, 13 cases showed R and six cases had No response (NR). After three months, rates of CR were 80% and 23.3% in group A and B; respectively. Responses were 16.7% and 33.3%, NRs were 6.6% and 43.3% in group A and B; respectively (P？<？0.0001). After 6 months, CR was 73.3% vs.16.7%, and R was 16.7% vs.36.7% and NR was 10% vs. 46.7% in group A and B; respectively (P？<？0.0001). After 12 months, there was no change in response rate in group A, but in group B 53% were non responsive, 40% showed R (chronic ITP) and complete response was observed only in 6.7% (P？<？0.0001). Three cases in group A and 12 cases in group B had needed splenectomy (P？<？0.00002).We showed that high dose dexamethasone is more effective than conventional steroid therapy in newly diagnosed ITP as initial treatment with less relapses and toxicities.The primary immune thrombocytopenia (ITP) is an isolated thrombocytopenia without exogenous etiologic factors and secondary causes ( [1,2]). Pathogenesis of ITP is due to platelet specific autoantibodies (most commonly IgG type) that bind to the platelet surface and cause clearance of them in spleen and liver ( [3,4]). Treatment in patients with ITP is dynamic and may alter in various situations. Patients with life threatening bleeding