Abstract Number: PB0834
Meeting: ISTH 2021 Congress
Background: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune condition treated with corticosteroids. Traditionally long-term prednisolone (PDN) has been used. Recently high-dose dexamethasone (HD-DXM), 40mg for four days, reported higher rates of complete response (CR) and similar sustained remission (SR). HD-DXM therefore became our first line treatment for acute ITP in 2016.
Aims: To compare outcomes, including response, retreatment, use of additional therapies and bleeding, for treatment naïve ITP patients managed with conventional PDN versus short course HD-DXM at our institution.
Methods: Retrospective review of all patients with treatment naïve ITP at Sir Charles Gairdner Hospital from January 1st 2014 to December 31st 2018. Partial response (PR) and CR were defined as rise in platelet count > 30 x 109/L and >100 x 109/L respectively, with at least a two-fold increase from baseline. SR required maintenance for six months. HD-DXM cycles were 10 days, PDN cycles 28 days long.
Results: 44 patients were identified. Initial treatment was PDN in 21, HD-DXM in 19 and four received other therapies. Response to cycle 1 (C1) treatment was 90% in the PDN (81% CR, 43% SR) and 88% in the HD-DXM cohort (59% CR, 35% SR). In C1, 16 patients received intravenous immunoglobulin (IVIG). Eight patients were retreated with HD-DXM: two achieved response, five switched to PDN/alternate therapies and one never responded. Overall, 66% achieved SR with additional therapy required (41%). 20.5% were lost to follow-up or died. Bleeding rate was similar between PDN and HD-DXM cohorts (11 actionable bleeds each). Two HD-DXM patients had major gastrointestinal haemorrhage, resulting in one death.
Conclusions: Similar rates of response were seen between cohorts. Most patients who were retreated with HD-DXM did not respond to HD-DXM alone. Many patients received early IVIG without waiting for steroid response and yet there was still a high rate of clinically actionable bleeding.
To cite this abstract in AMA style:Lewis C, Ng Z, Grove C. Idiopathic Thrombocytopenic Purpura: Conventional Prednisolone vs High-dose Dexamethasone [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/idiopathic-thrombocytopenic-purpura-conventional-prednisolone-vs-high-dose-dexamethasone/. Accessed September 16, 2021.
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