MAINTENANCE LOW-DOSE CORTICOSTEROID THERAPY IN PATIENTS WITH CHRONIC ITP: SINGLE CENTER RESULTS

Objective

Immune thrombocytopenia (ITP) is an acquired, autoimmune disease affecting 2 to 4 individuals per 100,000 annually. ITP is characterized by an isolated platelet count of <100 × 10³/μL. The diagnosis of primary ITP relies on excluding non-immune causes of thrombocytopenia (myelodysplastic syndrome, inherited thrombocytopenia) and secondary immune thrombocytopenia caused by other conditions such as autoimmune diseases (systemic lupus erythematosus), malignancies (chronic lymphocytic leukemia), infections (hepatitis C virus and HIV), and medications. The clinical manifestations of ITP range from entirely asymptomatic patients to increased petechiae-ecchymosis and rarely major or life-threatening bleeding. Corticosteroids are the first-line treatment. Initial treatment for ITP consists of methylprednisolone at a dose of 1mg/kg/day or dexamethasone administered at 40mg/day for 4 days, repeated every 14-28 days. While >75% of adult patients respond to corticosteroids, only 20-30% remain in continuous remission after cessation."

Methodology

We have 114 registered patients with immune thrombocytopenia (ITP) in our clinic over the past 5 years. Among these patients, a subgroup of 45 who received high-dose corticosteroid treatment as first-line therapy, responded to corticosteroids, but subsequently experienced loss of response, was identified as corticosteroid-sensitive. This group was selected for follow-up with maintenance low-dose steroid (LDS) therapy for 1 year. Patients were treated with 4 mg of methylprednisolone for 4 days per month and followed up for 12 months. Among our patients, 18 achieved response with platelet levels >30 × 10 ³ / μ L without signs of bleeding (see Table 1), while in 27 patients, additional corticosteroid doses were added or second-line treatment modalities such as splenectomy or eltrombopag were initiated due to platelet levels dropping below 30 × 10 ³ / μ L "

Results:

Conclusion

The goal of treatment in a patient with ITP is not only to normalize platelet counts but also to achieve a level of platelets that can prevent clinically significant bleeding. Based on this premise, we have demonstrated that maintenance corticosteroid therapy at an acceptable cumulative dose can reliably maintain platelet levels within a safe range. We believe that this should be further supported by larger multicenter studies."