High-dose dexamethasone versus prednisone as first-line therapy in newly diagnosed immune thrombocytopenic purpura in children

Background Immune thrombocytopenia (ITP) represents one of the most common acquired immune-mediated bleeding disorders observed in pediatric populations. The aim of this work was to compare the results of high-dose dexamethasone (HDD) and prednisone (PDN) as a primary therapeutic approach for newly diagnosed ITP in children. Patients and methods This prospective controlled randomized clinical trial was conducted on 60 children with newly diagnosed ITP who were split up into two groups. Group I: 30 patients who received PDN 2 mg/kg/day for 7 days and group II: 30 patients who received dexamethasone 0.6 mg/kg/day (maximum dosage 40 mg/day) by successive four intravenous infusions repeated every 2 weeks for four consecutive cycles. Results The PDN and HDD groups had early response rates of 80 and 86.67% ( P =0.488), early rates of responsiveness of 86.67 and 90% ( P =0.688), and durable response rates of 83.33 and 86.67% ( P =0.718). The remission rate was 76.67 versus 80% in the PDN group and HDD group, respectively, at 1 year after treatment. Bleeding score improvement rates were 94.72 and 82.79% ( P =0.069) in the HDD and PDN groups, respectively, with no significant difference. Weight gain was higher in the PDN group compared to the HDD group (73.33 vs. 23.33%, P ˂0.001) 1 month after treatment. Conclusions HDD might be used as a frontline therapy in pediatrics with newly diagnosed primary ITP.