Prednisone vs dexamethasone as the first-line treatment of ITP

Do you use prednisone or dexamethasone in the first-line treatment of immune thrombocytopenia (ITP)?

Mark Crowther: I use 40 mg of dexamethasone once a day for 4 days. The reason is that it gets people off the steroid much more quickly than the prednisone. They are probably equivalently effective, but if it was me, I would choose to take 4 days of very high dexamethasone rather than weeks or months of prednisone, with the risks of chronic exposure to prednisone therapy.

There is also some soft evidence based on a couple of randomized controlled trials that the high-dose dexamethasone may more favorably influence the likelihood of developing a remission from the ITP.

I routinely use dexamethasone as a first course. If the person relapses, which they frequently do, I oftentimes will use dexamethasone as a second course but sometimes I will put them on prednisone afterwards.