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Type: Artigo de periódico
Title: Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura
Author: Vancine-Califani, SMC
De Paula, EV
Ozelo, MC
Orsi, FLA
Fabri, DR
Annichino-Bizzacchi, JM
Abstract: In adults with immune thrombocytopenic purpura (ITP), steroids are usually proposed as first-line therapy, but long-term complete responses are obtained in no more than 20% of patients. For the remaining patients, splenectomy is considered the treatment of choice, with reported cure rates from 60-70%. However, the inherent risks of surgery and sepsis after splenectomy without a guarantee of success justify the search for strategies aimed to avoid splenectomy. Here we retrospectively evaluated the results of dapsone treatment in ITP patients that failed first-line therapy with steroids. These patients received dapsone 100 mg/day for a minimum of 30 days before splenectomy was considered. Efficacy was defined as a sustained rise in platelet counts (50 109/l) clearly attributed to dapsone treatment. Among 52 steroid-dependent or refractory patients, dapsone resulted in sustained increases in platelet counts in 44.2% of patients, after a median follow-up of 21.10 months after treatment initiation. The long-term efficacy of dapsone in this setting is further corroborated by the observation that none of the responding patients required splenectomy in the follow-up, compared to 69.0% of the non-responding patients. Dapsone-related adverse events were mild and promptly reversed by treatment withdrawal. The results of our retrospective analysis suggest that dapsone is a safe and effective second-line agent for steroid-dependent or refractory ITP patients. Because of its well-known safety profile and low cost compared to other potential second-line treatments for ITP, a trial course of dapsone should be viewed as an attractive option before splenectomy in steroid-dependent of refractory adult ITP patients.
Subject: ITP
Country: Inglaterra
Editor: Informa Healthcare
Citation: Platelets. Informa Healthcare, v. 19, n. 7, n. 489, n. 495, 2008.
Rights: fechado
Identifier DOI: 10.1080/09537100802315110
Date Issue: 2008
Appears in Collections:Unicamp - Artigos e Outros Documentos

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