Article: [Efficacy and safety of high-dose dexamethasone combined with rhTPO for newly diagnosed adults with severe immune thrombocytopenia]

Objective: To evaluate the efficacy and safety of high dose dexamethasone combined with recombinant human thrombopoietin (rhTPO) in adults with severe newly diagnosed immune thrombocytopenia (ITP).

Methods: Forty-eight adult patients with severe ITP were randomized into two groups, experimental group and control group. The patients in experimental group were given high-dose dexamethasone combined with rhTPO treatment, the patients in control group were given single high-dose dexamethasone treatment. Platelet count, platelet increase, as well as the overall response rate were strictly observed in the process. At the same time, the patient's drug tolerance and any adverse drug reactions were observed.

Results: The platelet counts and platelet increase of the patients in experimental group were significantly higher than that in control group (P<0.05) at day 3, 7, 14, 30. There was no significant difference in overall response rates between the two groups (34.8% vs 36.0%, 56.5% vs 48.0%, P>0.05) at day 3, 7. The overall response rates of experimental group at day 14, 30 were significantly higher than that of control group (91.3% vs 68.0%, 82.6% vs 52.0%, P<0.05). The muscle aches occurred in one patient in experimental group which was self-recovery without special treatment.

Conclusion: rhTPO combined with high-dose dexamethasone could rapidly increase the platelet count, reduce the risk of bleeding, and prolonge the effect with a low incidence of tolerable adverse events compared to single high-dose dexamethasone. rhTPO combined with high-dose dexamethasone could be a new therapeutic choice for severe primary ITP.

Citing Articles

[Thrombopoietin promotes megakaryopoiesis protecting bone marrow endothelial function in patients undergoing chemotherapy for hematological malignancies].

Zeng X, Jiao Y, Li Z, Zhang Y, Ye J Nan Fang Yi Ke Da Xue Xue Bao. 2020; 40(8):1134-1140.

PMID: 32895184 PMC: 7429173. DOI: 10.12122/j.issn.1673-4254.2020.08.10.

Efficacy and Safety of the Combination Treatment of Rituximab and Dexamethasone for Adults with Primary Immune Thrombocytopenia (ITP): A Meta-Analysis.

Wang J, Li Y, Wang C, Zhang Y, Gao C, Lang H Biomed Res Int. 2019; 2018:1316096.

PMID: 30648105 PMC: 6311778. DOI: 10.1155/2018/1316096.

Comparison of up-front treatments for newly diagnosed immune thrombocytopenia -a systematic review and network meta-analysis.

Arai Y, Jo T, Matsui H, Kondo T, Takaori-Kondo A Haematologica. 2017; 103(1):163-171.

PMID: 28971908 PMC: 5777203. DOI: 10.3324/haematol.2017.174615.

Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice.

Gonzalez-Lopez T, Fernandez-Fuertes F, Hernandez-Rivas J, Sanchez-Gonzalez B, Martinez-Robles V, Alvarez-Roman M Int J Hematol. 2017; 106(4):508-516.

PMID: 28667351 DOI: 10.1007/s12185-017-2275-4.

References

1.

Wang S, Yang R, Zou P, Hou M, Wu D, Shen Z . A multicenter randomized controlled trial of recombinant human thrombopoietin treatment in patients with primary immune thrombocytopenia. Int J Hematol. 2012; 96(2):222-8. DOI: 10.1007/s12185-012-1124-8. View

2.

Nakazaki K, Hosoi M, Hangaishi A, Ichikawa M, Nannya Y, Kurokawa M . Comparison between pulsed high-dose dexamethasone and daily corticosteroid therapy for adult primary immune thrombocytopenia: a retrospective study. Intern Med. 2012; 51(8):859-63. DOI: 10.2169/internalmedicine.51.7005. View

3.

Mazzucconi M, Fazi P, Bernasconi S, De Rossi G, Leone G, Gugliotta L . Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood. 2006; 109(4):1401-7. DOI: 10.1182/blood-2005-12-015222. View

4.

Rodeghiero F, Ruggeri M . ITP and international guidelines: what do we know, what do we need?. Presse Med. 2014; 43(4 Pt 2):e61-7. DOI: 10.1016/j.lpm.2014.02.004. View

5.

Bussel J, Lakkaraja M . Thrombopoietic agents: there is still much to learn. Presse Med. 2014; 43(4 Pt 2):e69-78. DOI: 10.1016/j.lpm.2014.02.008. View

6.

Khellaf M, Michel M, Schaeffer A, Bierling P, Godeau B . Assessment of a therapeutic strategy for adults with severe autoimmune thrombocytopenic purpura based on a bleeding score rather than platelet count. Haematologica. 2005; 90(6):829-32. View

7.

Cui Z, Wei Y, Hou M, Zhao H, Wang H . [The efficacy and safety of 2 cycles' high-dose dexamethasone treatment adult primary immune thrombocytopenia]. Zhonghua Nei Ke Za Zhi. 2011; 50(5):401-3. View

8.

Wormann B . Clinical indications for thrombopoietin and thrombopoietin-receptor agonists. Transfus Med Hemother. 2013; 40(5):319-25. PMC: 3822275. DOI: 10.1159/000355006. View

9.

Zhao Y, Wang Q, Zhai M, Xu J, Chen X, Liu W . [A multi-center clinical trial of recombinant human thrombopoietin in chronic refractory idiopathic thrombocytopenic purpura]. Zhonghua Nei Ke Za Zhi. 2004; 43(8):608-10. View

10.

Gu S, Zhuang J, Zou S, Li F, Wang Z, Cheng Y . [A clinical comparative study on treatment of severe newly diagnosed immune thrombocytopenia by recombinant human thrombopoietin combined with glucocorticoid]. Zhonghua Xue Ye Xue Za Zhi. 2013; 34(10):883-6. DOI: 10.3760/cma.j.issn.0253-2727.2013.10.012. View

11.

Mashhadi M, Kaykhaei M, Sepehri Z, Miri-Moghaddam E . Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru. 2013; 20(1):7. PMC: 3557140. DOI: 10.1186/2008-2231-20-7. View

[Efficacy and Safety of High-dose Dexamethasone Combined with RhTPO for Newly Diagnosed Adults with Severe Immune Thrombocytopenia]