Comparison of Single Course High-Dose Dexamethasone and Prednisone for Initial Treatment of Primary Immune Thrombocytopenia in Children: A Prospective Randomized Trial
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 10
Abstract
Introduction: Prednisone (PDN) is the most commonly used first-line treatment for primary immune thrombocytopenia (ITP) in children. Recently, a short-course high-dose dexamethasone (HD-DXM) therapy has been reported to be efficacious in childhood primary ITP. However, the choice of best corticosteroid as an initial therapy in primary ITP in children is still a matter of debate. Methods: This single-blind prospective randomized clinical trial was conducted at Pediatrics Department, NRS Medical College and Hospital, Kolkata, a tertiary care teaching institute in the state of West Bengal from the month of July 2014 to June 2017 to compare the efficacy and safety of HD-DXM and conventional PDN as firstline strategies for newly diagnosed primary ITP in children. Patients enrolled were randomized to receive DXM 20 mg/m2 /day for 4 days (n=49) or PDN 2.0 mg/kg/day for 10 day and then tapered over 2-3 weeks (n=47). Results: Single courses of HD-DXM resulted in a higher incidence of overall initial response (95.92% vs 82.98%, P = 0.049) and complete response (69.39% vs 34.04%, P = 0.001) compared with prednisone. Median time to response was shorter in the HD-DXM group [4 days (1-6) vs 6 days (2-9), P = < 0.0001). Bleeding was more effectively controlled on day 3 (P = 0.009) in children who had received HD-DXM compared with prednisone. Sustained response was achieved in 71.43% of patients in the HD-DXM arm and 42.55% in the PDN arm (P = 0.007). Initial complete response was associated with a decreased likelihood of loss of response. Both the corticosteroids were tolerated better with no statistically significant difference regarding treatment related overall toxicities (P = 0.0604). Conclusion: We concluded that HD-DXM could be a preferred corticosteroid strategy for first-line management of primary ITP in children.
Authors and Affiliations
Radheshyam Purkait, Rajarshi Basu
Keywords
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- EP ID EP239178
- DOI 10.9790/0853-1610014955
- Views 86
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