More from Reed Drews
I prefer a schedule of daily prednisone as the steroid regimen for newly diagnosed ITP, but I believe 6 weeks is far too short, as many patients who are steroid-responsive will “relapse” with rapid tapers. Here’s what I do, which is borrowed from time-honored classical hematologists like Stanley Schrier, now deceased.
- Prednisone 1 mg/kg/d for 2-3 weeks observing for response, followed by 0.75 mg/kg/d for 2 weeks, followed by 0.5 mg/kg/d for 2 weeks, followed by 0.25 mg/kg/d (generally 20 mg) for 4 weeks, followed by 15 mg/d for 2 weeks, followed by 10 mg/d for 2 weeks, followed by 7.5 mg/d for 2 weeks, followed by 5 mg/d for 2 weeks, followed by 2.5 mg/d for 2 weeks, then off. The goal is not to normalize platelet count levels for the entire duration of therapy but to achieve and maintain a platelet count in safe range, generally greater than 30-50 K/uL, depending on circumstances.
- If the patient has proven steroid-responsive ITP and they need a subsequent steroid course, then I use dexamethasone 40 mg daily x 4 days.