Abstract
Therapeutic plasma exchange (PE) is the accepted therapy for thrombotic thrombocytopenic purpura (TTP). Because not all patients achieve remission, other treatment modalities have been used in addition to PE, but no randomized clinical trial evaluated their efficacy. The aim of this multicentric study was to compare the effectiveness of standard- versus high-dose methylprednisolone as an adjunctive treatment to PE in the acute phase of TTP. Sixty patients with idiopathic TTP were randomized to receive methylprednisolone 1 mg/kg/die intravenous or 10 mg/kg/die for 3 days, thereafter, 2.5 mg/kg/die in addition to PE. Both dosages of steroids were well tolerated. At the end of induction therapy (day 23), the percentage of patients failing to achieve complete remission was significantly higher in the standard dose (16 of 30) than in the high-dose group (seven of 30). Also, the number of cases without a good response at day 9 and the number of deaths were higher in the standard-dose arm, but the differences did not reach the statistical significance. Results of present study indicate that the association of PE with high-dose instead of standard-dose steroids reduces the percentage of TTP patients that fail to achieve complete remission.
| Original language | English |
|---|---|
| Pages (from-to) | 591-596 |
| Number of pages | 6 |
| Journal | Annals of Hematology |
| Volume | 89 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2010 |
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Keywords
- Plasma exchange
- Steroids
- Thrombocytopenia
- TTP
ASJC Scopus subject areas
- Hematology
Cite this
High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura : A randomized study. / Balduini, Carlo L.; Gugliotta, Luigi; Luppi, Mario; Laurenti, Luca; Klersy, Catherine; Pieresca, Carla; Quintini, Gerlando; Iuliano, Francesco; Re, Rossana; Spedini, Pierangelo; Vianelli, Nicola; Zaccaria, Alfonso; Pogliani, Enrico Maria; Musso, Roberto; Bobbio Pallavicini, Enrico; Quarta, Giovanni; Galieni, Piero; Fragasso, Alberto; Casella, Gianluca; Noris, Patrizia; Ascari, Edoardo.
In: Annals of Hematology, Vol. 89, No. 6, 06.2010, p. 591-596.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - High versus standard dose methylprednisolone in the acute phase of idiopathic thrombotic thrombocytopenic purpura
T2 - A randomized study
AU - Balduini, Carlo L.
AU - Gugliotta, Luigi
AU - Luppi, Mario
AU - Laurenti, Luca
AU - Klersy, Catherine
AU - Pieresca, Carla
AU - Quintini, Gerlando
AU - Iuliano, Francesco
AU - Re, Rossana
AU - Spedini, Pierangelo
AU - Vianelli, Nicola
AU - Zaccaria, Alfonso
AU - Pogliani, Enrico Maria
AU - Musso, Roberto
AU - Bobbio Pallavicini, Enrico
AU - Quarta, Giovanni
AU - Galieni, Piero
AU - Fragasso, Alberto
AU - Casella, Gianluca
AU - Noris, Patrizia
AU - Ascari, Edoardo
PY - 2010/6
Y1 - 2010/6
N2 - Therapeutic plasma exchange (PE) is the accepted therapy for thrombotic thrombocytopenic purpura (TTP). Because not all patients achieve remission, other treatment modalities have been used in addition to PE, but no randomized clinical trial evaluated their efficacy. The aim of this multicentric study was to compare the effectiveness of standard- versus high-dose methylprednisolone as an adjunctive treatment to PE in the acute phase of TTP. Sixty patients with idiopathic TTP were randomized to receive methylprednisolone 1 mg/kg/die intravenous or 10 mg/kg/die for 3 days, thereafter, 2.5 mg/kg/die in addition to PE. Both dosages of steroids were well tolerated. At the end of induction therapy (day 23), the percentage of patients failing to achieve complete remission was significantly higher in the standard dose (16 of 30) than in the high-dose group (seven of 30). Also, the number of cases without a good response at day 9 and the number of deaths were higher in the standard-dose arm, but the differences did not reach the statistical significance. Results of present study indicate that the association of PE with high-dose instead of standard-dose steroids reduces the percentage of TTP patients that fail to achieve complete remission.
AB - Therapeutic plasma exchange (PE) is the accepted therapy for thrombotic thrombocytopenic purpura (TTP). Because not all patients achieve remission, other treatment modalities have been used in addition to PE, but no randomized clinical trial evaluated their efficacy. The aim of this multicentric study was to compare the effectiveness of standard- versus high-dose methylprednisolone as an adjunctive treatment to PE in the acute phase of TTP. Sixty patients with idiopathic TTP were randomized to receive methylprednisolone 1 mg/kg/die intravenous or 10 mg/kg/die for 3 days, thereafter, 2.5 mg/kg/die in addition to PE. Both dosages of steroids were well tolerated. At the end of induction therapy (day 23), the percentage of patients failing to achieve complete remission was significantly higher in the standard dose (16 of 30) than in the high-dose group (seven of 30). Also, the number of cases without a good response at day 9 and the number of deaths were higher in the standard-dose arm, but the differences did not reach the statistical significance. Results of present study indicate that the association of PE with high-dose instead of standard-dose steroids reduces the percentage of TTP patients that fail to achieve complete remission.
KW - Plasma exchange
KW - Steroids
KW - Thrombocytopenia
KW - TTP
UR - http://www.scopus.com/inward/record.url?scp=77951650730&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77951650730&partnerID=8YFLogxK
U2 - 10.1007/s00277-009-0877-5
DO - 10.1007/s00277-009-0877-5
M3 - Article
C2 - 20033409
AN - SCOPUS:77951650730
VL - 89
SP - 591
EP - 596
JO - Annals of Hematology
JF - Annals of Hematology
SN - 0939-5555
IS - 6
ER -