kjh The Korean Journal of Hematology Korean J Hematol 1738-7949 2092-9129 Korean Society of Hematology 10.5045/kjh.2009.44.1.28 kjh-44-28 Original Article The Effectiveness of High Dose Dexamethasone for the Initial Treatment of Childhood Acute Idiopathic Thrombocytopenic Purpura ChoiJun SeokM.D. HuhJae KyungM.D. YouChur WooM.D. Department of Pediatrics, College of Medicine, Eulji University, Daejeon, Korea Correspondence to：Chur Woo You, M.D. Department of Pediatrics, College of Medicine, Eulji University Hospital 1306, Dunsan-dong, Seo-gu, Daejeon 302-120, Korea Tel: ＋82-42-611-3352, Fax: ＋82-42-259-1111 E-mail: ycw1@eulji.ac.kr 032009 20032009 441 2835 10012009 12022009 18022009 Copyright © 2009 Korean Society of Hematology 2009 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

Corticosteroids and intravenous immunoglobulin (IV-Ig) have been used asfirst line treatments for acute idiopathic thrombocytopenic purpura (AITP) in children. High dose dexamethasone (HD) has been reported to be effective for chronic refractory ITP and for the initial treatment of AITP in adults. There has been no report about HD as the initial treatment for childhood AITP. We assessed the effectiveness of HD for the initial treatment of childhood AITP, as compared to IV-Ig.

 Methods

25 Patients with newly diagnosed AITP were enrolled. We conducted a prospective, randomized study to compare the two treatment options. 11 patients were treated with IV-Ig and 14 patients were treated with HD. The platelet counts were assessed at 3, 5, 7, 14 and 21 days after the beginning of the treatment. The adverse effects were noted, and the patients were followed for more than 6 months.

 Results

Both the IV-Ig and HD groups showed a rapid rise of the platelet counts and the platelet counts were maintained at 3, 5, 7, 14 and 21 days. The difference of platelet counts between the two groups was significant at day 5 (P＜0.05). During the follow-up period, 5 patients had a recurrence: 2 in IV-Ig group and 3 in HD group. All 5 patients were re-treated with HD and they had a good response. One of the recurred patients in the IV-Ig group had chronic ITP. Some side effects were observed, but they were not severe enough to necessitate the discontinuation of treatment.

 Conclusion

We conclude that HD is as effective and safe as high dose IV-Ig for the initial treatment of childhood AITP. The choice between these treatment options can be made according to the cost-effectiveness and the therapy-related risks.

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The effectiveness of HD compares to IV-Ig. Bars represent mean±SD (P＜0.05).

Clinical characteristics of study groups

  HD IV-Ig Total
Cases, n 14 11 25
Sex (F/M) 6/8 6/5 12/13
Age, months 38.9±46.1 47.5±40.7 43.9±42.9
(Mean±SD)      

Abbreviations: HD, high dose dexamethasone; IV-Ig, Intravenous immunoglobulin.

Platelet response to treatment

Platelet count (×109/L) HD IV-Ig P-value
Pretreatment 12.6±11.4 14.2±12.7 0.345
Day 3 74.5±46.4 66.1±21.7 0.851
Day 5 297.4±116.4 198.2±67.3 0.021∗
Day 7 377.0±196.0 192.4±133.6 0.149
Day 14 405.2±188.0 231.6±141.1 0.112
Day 21 277.2±109.3 254.0±144.2 0.800

Abbreviations: See Table 1. ∗P-value＜0.05

Time to reach a platelet count of ＞20×109/L, ＞ 50×109/L, ＞100×109/L

  HD IV-Ig P-value
＞20×109/L (days) 2.6±0.5 2.6±0.5 1.000
＞50×109/L (days) 3.2±1.0 3.0±0.0 1.000
＞100×109/L (days) 4.6±1.5 5.2±0.7 0.351

Abbreviations: See Table 1.

Adverse effects of HD and IV-Ig treatment

Adverse effects HD patient, n (%) IV-Ig patient, n (%)
Headache 0 (0.0) 1 (10.0)
Fever 1 (8.3) 2 (20.0)
Irritability 1 (8.3) 0 (0.0)
Facial flush 1 (8.3) 0 (0.0)
Vomiting 2 (16.6) 1 (10.0)
Weight gain 0 (0.0) 0 (0.0)
Increased appetite 0 (0.0) 0 (0.0)
Oliguria 0 (0.0) 0 (0.0)
Glycosuria 0 (0.0) 0 (0.0)
Total 5 (41.6) 4 (44.0)

Abbreviations: See Table 1.