Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with immune thrombocytopenia

Purpose: We aimed to compare the efficacy of high-dose methylprednisolone (HDP) with intravenous immunoglobulin (IVIG) and conventional prednisolone (CDP) as a first-line therapy in adult patients with immune thrombocytopenia (ITP). Materials and Methods: This retrospective study included 140 adult patients with either previously untreated newly diagnosed ITP (n=51) or persistent or chronic ITP (n=22/n=67)) with episodes. Patients with a platelet count <30x10(9)/L or <50x10(9)/L with a clinically significant bleeding were treated either by CDP therapy (1mg/kg/d until response) or HDP (20 mg/kg/d for 3 d) or IVIG (1g/kg/d for 2 d). The patients in all groups continued treatment with oral prednisolone (1 mg/kg/d) until their platelet counts stabilized. After therapy, patients' responses and clinical courses were evaluated. Results: The initial platelet counts were similar in all groups. HDP was given to 92 patients (65.7%), IVIG to 32 (22.8%), and CDP to 16 (11.4%). Although the HDP group showed a first response sooner than the IVIG and CDP groups, the median platelet count at first response was similar in all groups. Long-term remission was greater in the HDP group (57.6%) than in the IVIG (37.5%) and CDP (25.0%) groups, and their respective recurrence rates were 62.8%, 81.3% and 88.9%. Conclusion: Our results indicate that HDP's relative effectiveness, low cost, and convenience of use continue to recommend it as a first-line therapy for adult patients with ITP.