Initiating corticosteroid therapy with conventional dose methylprednisolone (CDMP) did not improve clinical outcomes among hospitalized patients with immune thrombocytopenic purpura (ITP) compared with oral prednisone, according to the results of a study published in the Journal of European Haematology.
ITP is associated with an increased risk of bleeding, making the management of this serious complication paramount in this patient population. Current guidelines recommend conventional dose oral prednisone (CDOP) for initial therapy, but intravenous methylprednisolone — owing to its pharmacologic mechanism of action and delivery — may lead to improved outcomes.
For this prospective study, researchers accessed the CARMEN registry and identified 87 hospitalized patients with newly diagnosed ITP; the outcomes of patients treated with CDOP 1 mg/kg/day or CDMP 1 mg/kg/day were analyzed. Eligible patients had primary or secondary ITP, and a platelet count of less than 30×109/L.
Median time to response was 3 days in the CDMP group compared with 4 days in the CDOP group. Response rates were 87.5% and 89.0% in the CDMP and CDOP groups, respectively (P =1.0), and complete response rates were 71.0% and 65.0%, respectively (P =.6). Patients in the CDMP group achieved an earlier complete response at 6.5 days vs 17 days among patients in the CDOP group.
Thirty-seven adverse events were reported in 33.3% (29) of patients, with the most frequently reported adverse events being infections and diabetes mellitus.
The authors concluded that “this study did not demonstrate any significant advantages in initiating corticosteroid therapy using methylprednisolone as conventional-dose CDMP in hospitalized adults with ITP.”
Essilini A, Comont T, Germain J, et al. Pretreatment with standard-dose intravenous methylprednisolone does not improve outcomes in newly diagnosed immune thrombocytopenia (ITP) [published online January 23, 2018]. Eur J Haematol. doi: 10.1111/ejh.13032