Whether dexamethasone or prednisolone is the optimal first-line treatment in adults with newly diagnosed immune thrombocytopenia (ITP) remains controversial. We aimed to compare the efficacy and safety of dexamethasone and prednisolone in adults with newly diagnosed ITP. A systematic review and meta-analysis of randomized controlled trials (RCTs).

We searched Pubmed, Scopus, Cochrane Central Register of Controlled Trials, and Embase to identify relevant citations until May 16, 2024. RCTs comparing dexamethasone to prednisolone in adults with newly diagnosed ITP were included. The outcomes included early response (ER) at 1 week, initial response (IR) at 1 month, durable response (DR) at 6 months, persistent response (PR) at 12 months, and adverse events. The outcomes were pooled using the random-effect Mantel-Haenszel meta-analysis and reported as relative risks (RRs) alongside corresponding 95% confidence intervals (CIs). The certain of evidence of each outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

We included 8 RCTs with 427 and 404 participants receiving dexamethasone and prednisolone, respectively. Dexamethasone yielded higher IR rates than prednisolone (RR 1.21, 95% CI 1.09-1.34). However, there was no improvement in terms of ER, DR, and PR. No significant difference was observed between 1-2 cycles and 3 cycles of dexamethasone in terms of IR (p=0.23), DR (p=0.64), and PR (p=0.88). Adverse events occurred more frequently in the prednisolone arm (141 events) than the dexamethasone arm (71 events), but the number of patients who discontinued the treatment was similar between both arms.

Very low certainty of evidence suggests that dexamethasone may be preferred compared to prednisolone in newly diagnosed adults with immune thrombocytopenia. Our findings suggested that one cycle of dexamethasone with a possible rescue course could be the optimal dosage.

Disclosures

No relevant conflicts of interest to declare.

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2024
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