Treatment of acute childhood idiopathic thrombocytopenic purpura with methylprednisolone pulses at high doses

The current therapy of idiopathic thrombocytopenic purpura (ITP) includes corticosteroids, at standard or high doses, and intravenous immune globulins (IVIG). The aim of this study is to demonstrate the good results by using lower doses, compared with high dose methylprednisolone (HD-MP), which reduces possible adverse effects and costs. We assessed the clinical response to two different HD-MP doses (7.5 vs 15 mg/kg/day for 4 days). Thirty nine children with acute ITP completed the therapeutic protocol; among them, 19 patients received 7.5 mg/kg/day methylprednisolone (MP), 20 children received 15 mg/kg/day MP. Nineteen children reached complete response (CR), 11 of them with 7.5 mg/kg/d and 8 patients with 15 mg/kg/day, 11 children did not respond early but had CR with successive lower-dose of MP; the overall success rate in 39 patients was 77%. The platelet count took a median of 4 days to reach ≥30×10⁹/l. The platelet count rose faster in patients receiving the lower HD-MP; 5 days to reach ≥100×10⁹/l in the group treated with 7.5 mg/kg and 10 days in patients with 15 mg/kg/day. The response time is shorter than those reported for patients receiving oral continuous prednisone (PDN) at standard doses, but similar to IVIG. Our findings demonstrated that using 7.5 mg/kg/day MP instead of 15 mg/kg/d, gave similar results in terms of time to platelet rise, CR, and follow-up.