Use of Single- or Two-dose Pulse Methylprednisolone in the Treatment of Acute Immune Thrombocytopenic Purpura

Özet

Objectives: In immune thrombocytopenic purpura (ITP) treatment, the main goal is achieving the platelet level most rapidly forhemostasis. Pulse steroid therapy is common due to the rapid increase in the platelet count within the first 48 hours. Intravenous(IV) pulse steroid therapy is usually administered as a single methylprednisolone dose in the morning. Oral methylprednisoloneis generally used as two divided doses due to its half-life, but there is no efficacy study for the use of pulse methylprednisolonetherapy in two doses. In this study, we aimed to investigate whether the administration of single or double doses of pulse steroidtreatment, which is the cheapest and most economical way to treat patients, differ in terms of platelet count increase rate.Methods: The diagnosis of acute ITP was made based on the appropriate clinical, laboratory, and bone marrow findings andplatelet count <100.000/mm3. All the patients were diagnosed with bone marrow aspiration, and they were admitted to the hospital.All patients with platelet counts below 20000/mm3 and those who had wet purpura or active bleeding were treated. Patientsin need of treatment were randomly divided into two treatment groups with closed envelope method. The first group was given IVpulse methylprednisolone (30 mg/kg/day for three days and 20 mg/kg/day for four days) in the early morning hours. The secondgroup received the same daily dosages in two divided doses. Hemoglobin, white blood cell, and platelet counts were evaluatedbefore and on the first, second, third, fifth, and seventh days of treatment. To evaluate the rate of treatment response, plateletcounts over 20.000/mm3, 50.000/mm3, and 100.000/mm3 obtained on the first, second, third, and seventh days of treatment werecompared.Results: Sixty patients with acute ITP diagnosis receiving pulse steroid therapy were included in the study. Platelet counts of thepatients in group 2, who received pulse steroids in two doses, reached ≥20.000/mm³ on the second day [median, (2–3) days],≥50.000/mm³ on the third day [median, (2.7–3.5) days], ≥100.000/mm³ on the fifth day [median, (3–5) days], which were significantlylower than the platelet counts of the patients in the first group on the third day [median, (2–5) days], fifth day [median, (4–7)days], and seventh day [median, (4–7) days], respectively (p<0.001, p<0.001, p=0.004).Conclusion: This study shows that administration of IV pulse steroid therapy in two doses is more effective in increasing theplatelet count in early period in patients with acute ITP, especially whose platelet count is less than 20.000/mm³, and when weprefer to increase the platelet counts rapidly due to risk of intracranial hemorrhage.