Comparative study of intravenous high-dose dexamethasone versus intravenous methylprednisolone as an emergent therapy in severe primary immune thrombocytopenia

Background In severe immune thrombocytopenia (ITP), high-dose methylprednisolone (MP) alone or combined with intravenous immunoglobulin showed some efficacy. Reports of use of high-dose dexamethasone (HD-DXM) in this setting are lacking. Objectives To compare between the efficacy and safety of HD-DXM versus MP as an emergency therapy in patients with severe ITP. Patients and methods A total of 50 adult patients with primary severe ITP were divided into two groups (25 in each): HD-DXM was given 40 mg/day intravenous for 4 days, and MP was given 1 g/day intravenous for 3 days. Platelet count was compared on admission and on days 3 and 5 of therapy. After 1 week, response was defined as platelet count more than 30x109/l and complete response when platelet more than 100x109/l. Results The baseline characteristics of the two groups are well balanced. Mean platelet count on third day showed no significant difference between the two groups (P=0.19). On day 5, HD-DXM group achieved significantly higher platelet count (90.13 +/- 11.41x106/ml vs. 65.11 +/- 10.38x106/ml) than in MP group (P <= 0.001). Response and complete response rates after 1 week of therapy were statistically significant higher in HD-DXM group than in MP group (92 vs. 76%; P <= 0.001). Hypertension and hyperglycemia were more significant in MP group (28 and 40%, respectively) than in HD-DXM group (8 and 12%, respectively; P=0.01 and 0.01, respectively). Conclusion HD-DXM alone could provide an effective and well-tolerated corticosteroid modality in emergency setting of patients with severe ITP. Prospective randomized trials of HD-DXM alone or in combination with intravenous immunoglobulin for higher efficacy are warranted.