What is the role of steroid therapy in the treatment of chronic immune thrombocytopenia (ITP) in adults?

Updated: Nov 30, 2019
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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A course of steroid therapy is often administered upon the initial diagnosis in an effort to induce a sustained remission. The treatment of choice is high-dose dexamethasone given at a dose of 40 mg daily for 4 days for one or two courses. Wei et al reported that a high-dose dexamethasone regimen resulted in a higher overall initial response, complete response rates, and shorter time to response, compared with prednisone. [26] In another study, a 4-day course of high-dose dexamethasone (40 mg/d) was reported as an effective initial therapy for adults with ITP, with 50% of patients showing sustained platelet count of over 50,000/µL. [27]

Prednisone is usually administered at a dose of 1 mg/kg. Approximately two thirds of patients can be expected to show a therapeutic response with steroid therapy.

Steroids are usually continued until the platelet count reaches normal or greater than 50,000/µL, and then they are gradually tapered in 4-6 weeks. Methylprednisolone (30 mg/kg IV days 1-3, tapered every third day to 1 mg/kg) has also been used with similar results.

In general, only 15-25% of patients with chronic ITP are expected to have lasting remission; the remainder have disease characterized by frequent relapses and remissions.

Even if the platelet count normalizes, many patients can maintain platelet counts of more than 20,000-30,000/µL with lower doses of steroids during times of relapse. However, in approximately one third of patients with chronic ITP, steroids are not effective, either because of a failure in response or a steroid requirement that leads to unacceptable adverse effects (eg, glucose intolerance, GI bleeding).

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