Short Term Outcome of High Dose Dexamethasone Versus Prednisone In Children With Acute Immune Thrombocytopenic Purpura: A Single Center Trial

Abstract

Background: Corticosteroids are the first line treatment of immune thrombocytopenia (ITP). While high dose dexamethasone (HD-DXM) can be used as a first line therapy in adults, data about its use in children is scarce. Aim of the work: To compare the efficacy of short-course HD-DXM and standard prednisone (PDN) as a first-line treatment to achieve increase in platelet count among children with previously untreated primary ITP. Materials and Methods: This prospective randomized controlled open label clinical trial was conducted on 60 children with newly diagnosed ITP randomized to either HD-DXM or PDN (30 patients in each group). HD-DXM was given at a dose of 24mg/m2/day (maximum dose 40mg/day) for 4 consecutive days and PDN was given at a dose 2mg/kg/day (maximum dose 60mg/day) for 7 consecutive days. Complete blood count was done at days 0,2,4,7,14,30 and 60. Results: The mean age in HD-DXM and PDN groups were 6 ± 2.9 years and 6 ± 3.5 years respectively (p=0.89). Females and males were 16 (53.3%) and 14 (46.7%) in HD-DXM and 13 (43.3%) and 17 (56.7%) PDN groups (p=0.795). The main symptom was epistaxis in 30(50%) of cases, followed by purpura in 18(30%), gum bleeding in 10(16.6%), and subconjunctival hemorrhage in 2(3.4%). Initial mean platelet count in HD-DXM and PDN was 5.4± 2.9 x 103 μl and 5.2 ± 4.2 x103 μl (p=0.444). Platelet count was 66.9±42.2 x103 μl and 37.3±61.5 x103 μl in HD-DXM and PDN groups at day 2 (p=0.002), 176.6±134 x103 μl and 108.6±135.8 x103 μl at day 4 (p=0.011), 132±134.7 x103 μl and 173.8±101.5 x103 μl at day 7 (p=0.016). There was no significant difference between the 2 groups in platelet counts at day 14 , 30, 60 (p=0.271), (p=0.982) and (p=0.706) respectively. Conclusion: HD-DXM achieved an earlier but unsustained rise of platelet count in newly diagnosed ITP than PDN. However, both medicines yielded the same effect during follow up period of two months.

Keywords

• immune thrombocytopenia
• itp
• pediatrics
• high dose dexamethasone
• prednisolone
• egyptian
• children