Corticosteroid drugs—including prednisone, dexamethasone and deflazacort—are often the first-line treatment approach for ITP. Some research indicates that short courses of dexamethasone are preferable in treating newly diagnosed cases.1
Both prednisone and dexamethasone are types of corticosteroids, drugs based on a naturally occurring hormone produced by the adrenal glands involved in the control of inflammation, stress response, metabolism, behavior, electrolyte balance and more.2 Prednisone is prescribed for a number of diseases including asthma and other autoimmune diseases.
Prednisone and other corticosteroids disrupt the communication between the pituitary and adrenals, which can lead to adrenal insufficiency. It is very important that the corticosteroid dose be tapered gradually, especially after high dose or long-term use, giving the adrenals a chance to resume their natural hormone production.3
Dexamethasone, in combination with rituximab, has produced better results in newly diagnosed patients than dexamethasone alone.6
The usual starting dose of the corticosteroids prednisone or prednisolone for ITP patients is .5 to 2 milligram (mg)/ kilogram (kg) for two to four weeks before tapering, depending on the response.5 One kilogram is equal to 2.2 pounds; based on this, body weight would be divided by 2.2 to determine the starting dosage. For example, 120 pounds would equal a dose of 60 mg.
Dexamethasone is given at the rate of 40 mg per day for four days, equivalent to about 400 mg of prednisone a day. There is no taper. The series can be repeated periodically as needed.
A partial list of the possible side effects includes: cataracts, gastrointestinal discomfort, osteoporosis, obesity, moon face, hypertension (high blood pressure), diabetic metabolism (blood sugar changes), sleep disturbances (insomnia), psychiatric syndromes (mood changes), delayed wound healing, atrophy (muscle wasting, including the heart muscle), potassium loss, and changes in the skin.5
Side effects from corticosteroids can be difficult to manage and grow in severity if the treatment is continued for a long period of time.
The side effects of withdrawing from prednisone can also cause problems. It is important to work closely with your physician as the drug is discontinued.
While 50 to 90 percent of ITP patients see a rise in platelet counts with an initial high dose of corticosteroids, only 10 to 30 percent have a durable remission, and some of those may require further treatment.4
Anti-platelet antibodies generally attach to one of two regions on the platelets, either GPIIbIIIa or GPIb-IX. People with GPIb-IX antibodies do not respond as well to corticosteroids as those with GPIIbIIIa antibodies or no detectible antibodies.7
- Cheng Y et al. “Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone.” N Engl J Med. 2003 Aug 28;349(9):831-6.http://content.nejm.org/cgi/content/short/349/9/831
- Wikipedia: corticosteroid http://en.wikipedia.org/wiki/Corticosteroid
- Guignat L et al. “Glucocorticoid treatments and adrenal function.” Rev Prat. 2008 May 15;58(9):966-70 http://www.ncbi.nlm.nih.gov/pubmed/18672662
- Cines DB, Bussel JB. “How I treat idiopathic thrombocytopenic purpura (ITP).”Blood. 2005 Oct 1;106(7):2244-51. http://bloodjournal.hematologylibrary.org/cgi/content/full/106/7/2244
- Provan, D, “International consensus report on the investigation and management of primary immune thrombocytopenia,” Blood. 2010 Jan 14; 115 (2):168-86. http://bloodjournal.hematologylibrary.org/cgi/content/full/115/2/168
- Gudbrandsdottir S, "Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia." Blood. 2013 Jan 4.
- Zeng Q et al. "Relative efficacy of steroid therapy in immune thrombocytopenia mediated by anti-platelet GPIIbIIIa versus GPIbα antibodies." Am J Hematol. 2012 Feb;87(2):206-8.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304552/