CC BY-NC-ND 4.0 · TH Open 2017; 01(02): e73-e81
DOI: 10.1055/s-0037-1604168
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Dexamethasone for Acute Primary Immune Thrombocytopenia Compared to Prednisolone: A Systematic Review and Meta-analysis

Yasuyuki Arai
1   Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
2   Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States
,
Hiroyuki Matsui
1   Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Tomoyasu Jo
1   Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Tadakazu Kondo
1   Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Akifumi Takaori-Kondo
1   Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
14 July 2017 (online)

Abstract

Corticosteroids have been established as first-line therapy in acute primary immune thrombocytopenia (ITP), and the clinical guidelines recommend either dexamethasone (Dex) or prednisolone (PSL). The types and dosages of corticosteroids, however, have not yet been determined, because previous randomized control trials (RCTs) comparing Dex and PSL showed controversial results in terms of efficacy. To understand and interpret all available evidence, we conducted a systematic review and meta-analysis of RCTs. The main outcome measure was the incidence of sustained response (SR; platelet count >30 × 109/L for 6 months without concomitant treatments after the completion of the final therapies). Eight RCTs (totaling 704 patients) were included in this study. The incidence of SR showed no significant difference, while it was significantly higher in the Dex arm when used with posttherapy (more than one course of Dex or tapering corticosteroids added; risk ratio [RR], 1.82; 95% confidence interval [CI], 1.38–2.41; p < 0.01). A single course of Dex showed no significant difference. The overall response (platelet >30 × 109/L) at day 28 was significantly improved in the Dex arm (RR, 1.11; 95% CI, 1.01–1.22; p = 0.03) and Dex with posttherapy suppressed long-term relapse (RR of nonevent, 1.32; 95% CI, 1.10–1.59; p < 0.01). There were significantly fewer adverse events in the Dex arm (RR, 0.45; 95% CI, 0.37–0.55; p < 0.01). Use of Dex with posttherapy instead of PSL may be more beneficial as the initial therapy. Studies comparing Dex with other new strategies are essential to determine the most suitable therapeutic regimens for acute ITP.

Supplementary Material

 
  • References

  • 1 Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S. Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost 2008; 99 (01) 4-13
  • 2 Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med 2000; 160 (11) 1630-1638
  • 3 Psaila B, Bussel JB. Immune thrombocytopenic purpura. Hematol Oncol Clin North Am 2007; 21 (04) 743-759
  • 4 Provan D, Stasi R, Newland AC. , et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115 (02) 168-186
  • 5 Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther MA. ; American Society of Hematology. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117 (16) 4190-4207
  • 6 Cui ZG, Wei Y, Hou M, Zhao HG, Wang HY. [The efficacy and safety of 2 cycles' high-dose dexamethasone treatment adult primary immune thrombocytopenia]. Zhonghua Nei Ke Za Zhi 2011; 50 (05) 401-403
  • 7 Mashhadi MA, Kaykhaei MA, Sepehri Z, Miri-Moghaddam E. Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru 2012; 20 (01) 7
  • 8 Li ZY, Li DP, Yan ZL. , et al. [Effect of different therapeutic regimens on regulatory T cells in patients of primary immune thrombocytopenia]. Zhonghua Xue Ye Xue Za Zhi 2013; 34 (06) 478-481
  • 9 Bae SH, Ryoo H-M, Lee WS. , et al. High dose dexamethasone vs. conventional dose prednisolone for adults with immune thrombocytopenia: a prospective multicenter phase III trial. Blood 2010; 116 (21) Abstract 3687
  • 10 Wei Y, Ji XB, Wang YW. , et al. High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial. Blood 2016; 127 (03) 296-302
  • 11 Mithoowani S, Gregory-Miller K, Goy J. , et al. High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol 2016; 3 (10) e489-e496
  • 12 Praituan W, Rojnuckarin P. Faster platelet recovery by high-dose dexamethasone compared with standard-dose prednisolone in adult immune thrombocytopenia: a prospective randomized trial. J Thromb Haemost 2009; 7 (06) 1036-1038
  • 13 Din B, Wang X, Shi Y, Li Y. Long-term effect of high-dose dexamethasone with or without low-dose dexamethasone maintenance in untreated immune thrombocytopenia. Acta Haematol 2015; 133 (01) 124-128
  • 14 Matschke J, Müller-Beissenhirtz H, Novotny J. , et al. A randomized trial of daily prednisone versus pulsed dexamethasone in treatment-naïve adult patients with immune thrombocytopenia: EIS 2002 Study. Acta Haematol 2016; 136 (02) 101-107
  • 15 Cheng Y, Wong RS, Soo YO. , et al. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med 2003; 349 (09) 831-836
  • 16 Alpdogan O, Budak-Alpdogan T, Ratip S. , et al. Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with idiopathic thrombocytopenic purpura. Br J Haematol 1998; 103 (04) 1061-1063
  • 17 Liu XG, Ma SH, Sun JZ. , et al. High-dose dexamethasone shifts the balance of stimulatory and inhibitory Fcgamma receptors on monocytes in patients with primary immune thrombocytopenia. Blood 2011; 117 (06) 2061-2069
  • 18 Cuker A, Prak ET, Cines DB. Can immune thrombocytopenia be cured with medical therapy?. Semin Thromb Hemost 2015; 41 (04) 395-404
  • 19 Moulis G, Palmaro A, Montastruc JL, Godeau B, Lapeyre-Mestre M, Sailler L. Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France. Blood 2014; 124 (22) 3308-3315
  • 20 Huscher D, Thiele K, Gromnica-Ihle E. , et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis 2009; 68 (07) 1119-1124
  • 21 Fang Q, Qian X, An J, Wen H, Cope DK, Williams JP. Higher dose dexamethasone increases early postoperative cognitive dysfunction. J Neurosurg Anesthesiol 2014; 26 (03) 220-225