Duration of Corticosteroid Tapering as First Line Treatment In Idiopathic Thrombocytopenic Purpura.

Idiopathic Thrombocytopenic Purpura (ITP) is a relatively common benign hematologic disorder. Management of ITP is difficult as many treatment regimens present risks that may pose more harm than the disease itself. Typically, corticosteroid is used as first line treatment, but there is currently no evidence-based guideline to direct the optimal duration of therapy.

To investigate the effectiveness and relative safety of various lengths of corticosteroid therapy.

In a retrospective cohort study, charts of all ITP patients seen in the general hematology clinic at the London Health Sciences Centre (LHSC) from January 1, 2004 to December 31, 2009 were reviewed.

: A total of 312 patients with ITP were reviewed. 128 of the patients (52 male, 76 female), age range 4–94 at time of diagnosis, required corticosteroid treatment. Of those, 35 patients were treated with short term steroid regimen (< 8 weeks); 32 patients had 8–16 weeks of therapy, and 64 patients received long term steroid tapering regimen (>16 weeks). Based on results, 63%, 56% and 39% of patients achieved complete response in each group respectively. The follow-up duration from diagnosis ranged from 1 month to 29 years (with median of 1 year).

Interestingly, the same proportion of patients experienced side effects as a result of steroid use in all groups. However, frequency of serious complications such as avascular necrosis and infections, occurred at a higher rate in the long term therapy group (9%) compared to 0% in short term therapy group.

Rapid corticosteroid taper is as effective as a slow corticosteroid taper and has less serious side effects.

No relevant conflicts of interest to declare.