TO COMPARE THE EFFICACY(response rate) OF HIGH DOSE DEXAMETHASONE WITH CONVENTIONAL PREDNISOLONE IN THE TREATMENT OF NEWLY DIAGNOSED ADULT PATIENTS OF IMMUNTHROMBOCYTOPENIA PURPURA

Authors

  • Batool Butt Paf hospital islamabad
  • Uzma Qayyum army medical college/PEMH rawalpindi
  • Hareem Butt
  • Omar ahsan fondation university medical college
  • Farooq
  • Humaira Erum PAF Hospital Islamabad
  • Jawwad Khan Fauji Foundation Medical College Rawalpindi

DOI:

https://doi.org/10.55519/JAMC-03-9786

Keywords:

Immune thrombocytopenia purpura, management, high dose dexamethasone, conventional prednisolone, response rate

Abstract

Background: Immune thrombocytopenic purpura with multimodal incidence having peaks in each age groups is a chronic clinical syndrome in adults, with disease more predominant in females in adults. The aim of the study was to compare the efficacy (response rate) of high dose dexamethasone with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenic purpura. It was a prospective quasi-experimental study, conducted at the Department of Medicine of a tertiary care hospital from Jan to Dec 2019. Subjects and Methods: The sample population comprised of 130 cases of newly diagnosed ITP patients, having platelet count <30,000/ul with or without bleeding symptoms who received either dexamethasone (40 mg/day for 04 days) or prednisolone (0.5–1 mg/kg PSL for 01 week). Treatment response was measured at day 7. Results: Out of 130 patients 65 patients were treated with dexamethasone and 65 patients with prednisolone .83.08% (n=54) cases in Group-A and 33.85% (n=22) in Group-B had response while remaining 16.92% (n=11) in Group-A and 66.15% (n=43) in Group-B had no response. The p value was calculated as 0.000 which shows a significant difference. Conclusion: We concluded that high dose of dexamethasone shows a significantly higher response when compared with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenia purpura.     

References

Kohli R, Chaturvedi S. Epidemiology and Clinical Manifestations of Immune Thrombocytopenia. Hamostaseologie 2019;39(3):238–49.

Zufferey A, Kapur R, Semple JW. Pathogenesis and Therapeutic Mechanisms in Immune Thrombocytopenia (ITP). J Clin Med 2017;6(2):16.

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(1):7.

Li J, Sullivan JA, Ni H. Pathophysiology of immune thrombocytopenia, Curr Opin Hematol 2018;25(5):373–81.

Audia S, Mahévas M, Samson M, Godeau B, Bonnotte B. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017;16(6):620–32.

Wei Y, Ji XB, Wang YW, Wang JX, Yang EQ, Wang ZC, et al. High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia: a prospective multicenter randomized trial. Blood 2016;127(3):296–302.

Matschke J, Müller-Beissenhirtz H, Novotny J, Vester I, Hertenstein B, Eisele L, et al. A randomized trial of daily prednisone versus pulsed dexamethasone in treatment-naive adult patients with immune thrombocytopenia: EIS 2002 Study. Acta Haematol 2016;136(2):101–7.

Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 2019;3(23):3829–66.

Mithoowani S, Gregory-Miller K, Goy J, Miller MC, Wang G, Noroozi N, 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):e489–96.

Cuker A, Cines DB, Neunert CE. Controversies in the treatment of immune thrombocytopenia. Curr Opin Hematol 2016;23(5):479–85.

Lambert MP, Gernsheimer TB. Clinical updates in adult immune thrombocytopenia. Blood 2017;129(21):2829–35.

Xu J, Zhang X, Feng S, Zhao N, Hu X, Cheng Y, et al. Clinical efficacy of high-dose dexamethasone with sequential prednisone maintenance therapy for newly diagnosed adult immune thrombocytopenia in a real-world setting. J Int Med Res 2021;49(4):3000605211007322.

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(1):124–8.

Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 2019;3(22):3780–817.

Sadeghi A, Hosseini SF, Jouzdani SR. Evaluation of treatment plan by three-period pulses of high-dose dexamethasone among patients with primary immune thrombocytopenia on platelet count response and adverse events: A randomized Clinical trial. J Res Med Sci 2020;25:88.

Moulis G, Germain J, Comont T, Brun N, Dingremont C, Castel B, et al. Newly diagnosed immune thrombocytopenia adults: clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort. Am J Hematol 2017;92(6):493–500.

Published

2022-06-21

Issue

Vol. 34 No. 3 (2022): JOURNAL OF AYUB MEDCIAL COLLEGE ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.