High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults

Ann Hematol. 2004 Dec;83(12):764-8. doi: 10.1007/s00277-004-0908-1. Epub 2004 Aug 10.


The current first-line choice of treatment of idiopathic thrombocytopenic purpura (ITP) in adults, prednisone, is effective but has many side effects. Furthermore, reduction of the dose leads to a relapse of ITP in a majority of cases. Courses of high-dose dexamethasone (HD) aim to avoid these problems. We treated 36 patients with newly diagnosed or recurrent ITP with an 8-day course of HD, with a peak dose of 40 mg/day. The courses were repeated up to a maximum of six courses, with a 28-day interval. Acute and chronic effects of HD on platelet counts were observed, as well as side effects. HD led to an acute response (rise of platelet count to a level above 50 x 10(9)/l) in 83%. When HD was given as a first-line treatment, 59% of patients were still in remission after 31 months. When HD was given as a second-line treatment, 50% of patients were in remission after 5 months, declining to 25% after 54 months. Side effects were frequent but rarely dangerous. In conclusion, acute effects of HD were excellent. Long-term effects of HD as a first-line therapy of ITP were good, but its long-term effects as a second-line therapy were much poorer.

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Dexamethasone / administration & dosage*
  • Dexamethasone / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Glucocorticoids / administration & dosage*
  • Glucocorticoids / adverse effects
  • Humans
  • Male
  • Middle Aged
  • Platelet Count
  • Prednisone / adverse effects
  • Prednisone / therapeutic use
  • Purpura, Thrombocytopenic, Idiopathic / blood
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy*
  • Purpura, Thrombocytopenic, Idiopathic / pathology
  • Recurrence
  • Remission Induction


  • Glucocorticoids
  • Dexamethasone
  • Prednisone