High Dose Dexamethasone Vs. Conventional Dose Prednisolone in Adult ITP

"Pulse high dose dexamethasone (Arm 1)~1. Patients will receive 40 mg of oral dexamethasone daily for four consecutive days.~2. Other treatments should be considered if there was a platelet count of 30X109/L or less by day 14~3. If the patient had a platelet count of more than 30X109/L after four days of dexamethasone treatment, no further treatment will be given.~4. If the platelet count drops below 30X109/L within the first 6 months, another four-day course of dexamethasone will be given, followed by 15 mg of prednisone daily, with gradual tapering.~5. Patients whose platelet counts can not be maintained at 30X109/L will be offered other treatments."

"Conventional dose prednisone (Arm 2)~1. Prednisone, 1 mg/kg is started at diagnosis. If the platelet count is more than 100X109/L, the dose should be used for 4 weeks minimally and then tapered by 10 mg/1 wk until the dose reaches 0.5 mg/kg of body weight and by 5 mg/1 wk thereafter. (Ann Intern Med 1997, 126, 307-14). If the platelet count is between 30X109/L and 100X109/L, prednisone 1 mg/kg should be used for 8 weeks maximally and then tapered by 10 mg/2 wk until the dose reaches 0.5 mg/kg of body weight and by 5 mg/2 wk thereafter.~2. Guideline of prednisone tapering Duration of prednisone treatment: 3-6 months"