High Dose Dexamethasone Vs. Conventional Dose Prednisolone in Adult ITP

A Randomized Controlled Multicentre Trial of High Dose Dexamethasone Versus Conventional Dose Prednisolone for Adults With Untreated Idiopathic Thrombocytopenic Purpura

To determine the long term effects of pulse high dose dexamethasone and conventional dose prednisolone in treatment of adult patients with ITP.

Patients will be randomized to one of two study arms:

dexamethasone 40 mg po daily for 4 consecutive days. If the platelet count drops below 30X109/L after response within 6 months, another four-day course of dexamethasone will be given, followed by 15 mg of prednisone daily, with gradual tapering (Arm 1).

Prednisone 1 mg/kg po daily for 4-8 weeks, the drug is then decreased slowly over another few weeks (Arm 2).

Inclusion Criteria :

• a true thrombocytopenia on blood smear
• adequate megakaryopoiesis on bone marrow examination
• the absence of clinically apparent associated conditions or cause of thrombocytopenia
• Age over 16 years
• A platelet count of less than 30x109/L

Exclusion criteria :

• previous treatment for ITP.
• other causes of thrombocytopenia such as HIV infection, lymphproliferative disease, liver disease, or definite SLE.
• Patients with life threatening bleeding and pregnant women should be excluded.