INTRODUCTION: Idiopathic thrombocytopenia purpura in adults has a greater likelihood of becoming refractory compared with children even after treatment. For years, this disease has been treated with immunosuppressives, particularly prednisone. However, new treatment options are emerging with better efficacy and fewer side effects.
METHODS: The focus of this study was to review the current literature for the la.st 10 years on all studies pertaining to the first . line treatment in new onset adult rTP, by comparing the long term completeremission rates. The five treatments reviewed included prednisone, high dose methylprednisolone (HDMP), high dose dexamethasone (HDD), intravenous immunoglobulin (IVIg), anti D or a combination of these.
RESULTS: Of the 6 studies published, high-dose dexamethasone, when given at 40mg/kg/day for four days every 14 days for a total of four cycles, has the best overall efficacy at maintaining complete remission at 6 months after treatment was discontinued.
CONCLUSION: High dose dexamethasone is currently the most effective first line therapy for new onset ITP in adults. However, further randomized trials and longer term studies are needed to better substantiate its use and/or the use of the other first line therapies.
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