Effect of Low-Dose Prednisolone Durations on Loss of Response Rates in Patients with Immune Thrombocytopenia
Keywords:
Low-dose prednisolone, Relapse, Loss of response, Immune thrombocytopeniaAbstract
Background and Objective: Currently, the standard first-line treatment for patients with immune thrombocytopenia (ITP) patients is corticosteroids. Although most patients are responses to treatment, two-thirds of patients relapse or loss of response after discontinuing medication. The objective of this study was to evaluate the association between low-dose prednisolone durations (≤10 mg/day) and event (loss of response or relapse) rates in ITP patients.
Methods: The retrospective cohort study collected data from medical records of patients diagnosed ITP, treated at Khon Kaen Hospital from October 31st, 2011 to November 1st, 2020. The data were analyzed using Kaplan-Meier curve to analyze survival, Cox regression and log-rank test to compare between groups.
Results: One hundred and eighteen ITP patients were included, 78% were female, 82% were newly diagnosed ITP, mean age was 47.4 ± 17.5 years, 78.8% reached complete response after initial treatment. Median event-free survival after started low-dose prednisolone (LDP) in patients received LDP duration ≤6 months compare with LDP duration >6 months was 7.2 months (95%CI, 5.0 – 22.8) and 34.4 months (95%CI, 17.8 – 79.5), respectively, with hazard ratio 2.24 (95%CI, 1.39 – 3.65). Adverse effects from corticosteroids therapy in this study were not statistically significant differences between the two groups of patients.
Conclusions: Low-dose prednisolone treatment duration no more than 6 months was associated with higher rates of relapse or loss of response in ITP patients.
References
Cooper N, Ghanima W. Immune Thrombocytopenia. N Engl J Med 2019;381(10):945-55.
Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009;113(11):2386-93.
Abrahamson PE, Hall SA, Feudjo-Tepie M, Mitrani-Gold FS, Logie J. The incidence of idiopathic thrombocytopenic purpura among adults: a population-based study and literature review. Eur J Haematol 2009;83(2):83-9.
Piel-Julian ML, Mahevas M, Germain J, Languille L, Comont T, Lapeyre-Mestre M, et al. Risk factors for bleeding, including platelet count threshold, in newly diagnosed immune thrombocytopenia adults. J Thromb Haemost 2018;16(9):1830-42.
Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 2019;3(23):3829-66.
Mithoowani S, Gregory-Miller K, Goy J, Miller MC, Wang G, Noroozi N, et al. High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol 2016;3(10):e489-e96.
Moulis G, Germain J, Comont T, Brun N, Dingremont C, Castel B, et al. Newly diagnosed immune thrombocytopenia adults: Clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort. Am J Hematol 2017;92(6):493-500.
Stasi R, Stipa E, Masi M, Cecconi M, Scimo MT, Oliva F, et al. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. Am J Med 1995;98(5):436-42.
Pirunsarn A, Kijrattanakul P, Chamnanchanunt S, Polprasert C, Rojnuckarin P. A randomized multicenter trial comparing low-dose prednisolone versus observation for prevention of recurrences in adult immune thrombocytopenia. Clin Appl Thromb Hemost 2018;24(6):867-73.
Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS. Long-term side effects of glucocorticoids. Expert Opin Drug Saf 2016;15(4):457-65.
Praituan W, Rojnuckarin P. Faster platelet recovery by high-dose dexamethasone compared with standard-dose prednisolone in adult immune thrombocytopenia: a prospective randomized trial. J Thromb Haemost 2009;7(6):1036-8.
DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Adult idiopathic thrombocytopenic purpura. Clinical findings and response to therapy. Am J Med 1980;69(3):430-42.
Bellucci S, Charpak Y, Chastang C, Tobelem G. Low doses v conventional doses of corticoids in immune thrombocytopenic purpura (ITP): results of a randomized clinical trial in 160 children, 223 adults. Blood 1988;71(4):1165-9.
Saag KG, Koehnke R, Caldwell JR, Brasington R, Burmeister LF, Zimmerman B, et al. Low dose long-term corticosteroid therapy in rheumatoid arthritis: an analysis of serious adverse events. Am J Med 1994;96(2):115-23.
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