Efficacy and Safety of Dapsone As Second Line Therapy for Adult Immune Thrombocytopenia: A Retrospective Study of 42 Patients

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2017 Oct 31

PMID 29084292

Citations 5

Authors

Clementine Esteve

Maxime Samson

Alexandre Guilhem

Barbara Nicolas

Vanessa Leguy-Seguin

Sabine Berthier

Bernard Bonnotte

Sylvain Audia

Affiliations

Soon will be listed here.

Abstract

Dapsone is recommended as a second line therapy in immune thrombocytopenia (ITP), but is underused because of its potential side effects. The medical charts of 42 ITP patients treated with dapsone (100 mg/day) were retrospectively reviewed in order to assess its efficacy and safety in daily clinical practice. The overall response rate was 54.8% (n = 22, with a complete response in 38.1%) with a median time to response of 29 days (24-41 days). Patients with complete response had shorter disease duration whereas no difference was observed between responders and non-responders regarding age, sex or previous treatments received. Importantly, after dapsone withdrawal, a sustained response was observed in 5 patients, representing 12% of the whole cohort. Twenty percent of patients (n = 8) relapsed on therapy after 8.1 (6.5-13.6) months. Side effects occurred in 31% (n = 13) of patients, and required dapsone withdrawal in 22% (n = 9) or dosage reduction in 10% (n = 4) of the cases. Side effects resolved in all but one case. Overall, these data support dapsone as an interesting second line therapy in ITP, with a good safety and efficacy profile at a low cost.

Citing Articles

Analyzing the Systems Biology Effects of COVID-19 mRNA Vaccines to Assess Their Safety and Putative Side Effects.

Hajjo R, Sabbah D, Tropsha A Pathogens. 2022; 11(7).

PMID: 35889989 PMC: 9320269. DOI: 10.3390/pathogens11070743.

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand.

Choi P, Merriman E, Bennett A, Enjeti A, Tan C, Goncalves I Med J Aust. 2021; 216(1):43-52.

PMID: 34628650 PMC: 9293212. DOI: 10.5694/mja2.51284.

A retrospective analysis of 122 immune thrombocytopenia patients treated with dapsone: Efficacy, safety and factors associated with treatment response.

Colella M, Orsi F, Alves E, Delmoro G, Yamaguti-Hayakawa G, de Paula E J Thromb Haemost. 2021; 19(9):2275-2286.

PMID: 34018665 PMC: 8456876. DOI: 10.1111/jth.15396.

Is dapsone still relevant in immune thrombocytopenia in resource limited settings?.

Dalal P, Gulia M, Gupta M, Tahlan A BMJ Case Rep. 2019; 12(12).

PMID: 31862814 PMC: 6936470. DOI: 10.1136/bcr-2019-232217.

Treatments for Primary Immune Thrombocytopenia: A Review.

Samson M, Fraser W, Lebowitz D Cureus. 2019; 11(10):e5849.

PMID: 31754584 PMC: 6830854. DOI: 10.7759/cureus.5849.

References

Godeau B, Durand J, Roudot-Thoraval F, Tenneze A, Oksenhendler E, Kaplanski G . Dapsone for chronic autoimmune thrombocytopenic purpura: a report of 66 cases. Br J Haematol. 1997; 97(2):336-9. DOI: 10.1046/j.1365-2141.1997.412687.x. View

Vancine-Califani S, De Paula E, Castro Ozelo M, Orsi F, Fabri D, Annichino-Bizzacchi J . Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura. Platelets. 2008; 19(7):489-95. DOI: 10.1080/09537100802315110. View

Rodrigo C, Gooneratne L . Dapsone for primary immune thrombocytopenia in adults and children: an evidence-based review. J Thromb Haemost. 2013; 11(11):1946-53. DOI: 10.1111/jth.12371. View

Durand J, Lefevre P, Hovette P, Mongin M, Soubeyrand J . Dapsone for idiopathic autoimmune thrombocytopenic purpura in elderly patients. Br J Haematol. 1991; 78(3):459-60. DOI: 10.1111/j.1365-2141.1991.tb04467.x. View

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold D . Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2008; 113(11):2386-93. DOI: 10.1182/blood-2008-07-162503. View

Hernandez F, Linares M, Colomina P, Pastor E, Cervero A, Perez A . Dapsone for refractory chronic idiopathic thrombocytopenic purpura. Br J Haematol. 1995; 90(2):473-5. DOI: 10.1111/j.1365-2141.1995.tb05179.x. View

Patel A, Patil A . Dapsone for immune thrombocytopenic purpura in children and adults. Platelets. 2014; 26(2):164-7. DOI: 10.3109/09537104.2014.886677. View

Arnold D, Dentali F, Crowther M, Meyer R, Cook R, Sigouin C . Systematic review: efficacy and safety of rituximab for adults with idiopathic thrombocytopenic purpura. Ann Intern Med. 2007; 146(1):25-33. DOI: 10.7326/0003-4819-146-1-200701020-00006. View

Gonzalez-Lopez T, Pascual C, Alvarez-Roman M, Fernandez-Fuertes F, Sanchez-Gonzalez B, Caparros I . Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia. Am J Hematol. 2014; 90(3):E40-3. DOI: 10.1002/ajh.23900. View

10.

Cines D, Blanchette V . Immune thrombocytopenic purpura. N Engl J Med. 2002; 346(13):995-1008. DOI: 10.1056/NEJMra010501. View

11.

Damodar S, Viswabandya A, George B, Mathews V, Chandy M, Srivastava A . Dapsone for chronic idiopathic thrombocytopenic purpura in children and adults--a report on 90 patients. Eur J Haematol. 2005; 75(4):328-31. DOI: 10.1111/j.1600-0609.2005.00545.x. View

12.

. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003; 120(4):574-96. DOI: 10.1046/j.1365-2141.2003.04131.x. View

13.

Dutta T, Goel A, Ghotekar L, Hamide A, Badhe B, Basu D . Dapsone in treatment of chronic idiopathic thrombocytopenic purpura in adults. J Assoc Physicians India. 2002; 49:421-5. View

14.

Moss C, Hamilton P . Thrombocytopenia in systemic lupus erythematosus responsive to dapsone. BMJ. 1988; 297(6643):266. PMC: 1833929. DOI: 10.1136/bmj.297.6643.266. View

15.

Loustau V, Pourrat O, Mandelbrot L, Godeau B . [Immune thrombocytopenia and pregnancy: State of knowledge and unanswered questions]. Rev Med Interne. 2014; 36(3):167-72. DOI: 10.1016/j.revmed.2014.07.009. View

16.

Godeau B, Porcher R, Fain O, Lefrere F, Fenaux P, Cheze S . Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study. Blood. 2008; 112(4):999-1004. DOI: 10.1182/blood-2008-01-131029. View

17.

Gonzalez-Lopez T, Sanchez-Gonzalez B, Pascual C, Arefi M, de Cabo E, Alonso A . Sustained response after discontinuation of short-and medium-term treatment with eltrombopag in patients with immune thrombocytopenia. Platelets. 2014; 26(1):83-6. DOI: 10.3109/09537104.2013.870987. View

18.

Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther M . The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011; 117(16):4190-207. DOI: 10.1182/blood-2010-08-302984. View

19.

Meeker N, Goldsby R, Terrill K, Delaney K, Slayton W . Dapsone therapy for children with immune thrombocytopenic purpura. J Pediatr Hematol Oncol. 2003; 25(2):173-5. DOI: 10.1097/00043426-200302000-00019. View

20.

Bussel J, Provan D, Shamsi T, Cheng G, Psaila B, Kovaleva L . Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial. Lancet. 2009; 373(9664):641-8. DOI: 10.1016/S0140-6736(09)60402-5. View