Low-Dose Versus High-Dose Prednisone in ITP During Pregnancy

Researchers performed a study to compare the clinical efficacy and side effects of low-dose (LD) oral prednisone against results from a previous high-dose (HD) study in patients with severe immune thrombocytopenia (ITP) during pregnancy. In Frontiers in Pharmacology, they reported that LD prednisone therapy led to comparable efficacy to HD therapy but a significantly reduced incidence of hypertension.

The study included 43 pregnant patients with severe ITP (platelet count <30 × 10⁹/L) between January 2015 and 2019. Patients were administered oral prednisone at doses ranging from 0.25 to 0.5 mg/kg as first-line treatment for ITP. The primary end point (response rate) and secondary end points (maternal hemorrhagic events, complications, and neonatal outcomes) were compared with results from 31 patients in the 1 mg/kg HD study.

Low-Dose Prednisone May Be Superior to High-Dose

According to the report, 15 (35%) out of 43 patients with ITP during pregnancy responded to the LD corticosteroid therapy, of which 4 patients achieved a complete response. This rate was comparable to the 35.5% response rate recorded with HD therapy.

A total of 10 (30%) patients experienced bleeding symptoms, which were improved after 14 days of LD prednisone. Three patients experienced preeclampsia for an incidence of 7% compared with an incidence of 18% in the HD study. Finally, the authors noted neonatal outcomes were comparable between the studies, and there were no stillbirths or miscarriages with LD prednisone.

The authors summarized that “this study suggests lower-dose prednisone treatment in severe ITP during pregnancy is not less effective than higher-dose prednisone treatment, and it reduces the incidence of maternal complications.”

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