Oral cyclic megadose methylprednisolone therapy for chronic immune thrombocytopenic purpura in childhood

The objectives of this study were to investigate the effectiveness of oral megadose methylprednisolone (OMMP) therapy in children with chronic immune thrombocytopenic purpura (ITP). Twenty-two patients were given oral methylp rednisolone daily for 7 d (30 mg/kg for 3 d and then 20 mg/kg for 4 d). OMM P therapy was repeated once per month if the platelet count was less than 2 0,000/mm(3) at the 30th day of therapy, for up to six courses. The number o f platelets of all patients increased gradually during the OMMP therapy, wi th a peak number at the 7th day, then decreased until the 14th day, and rem ained relatively stable until 12 months. During the study no patient had a platelet count less than 20,000/mm(3) at the 3rd day and 50,000/mm(3) at th e 7th day. Although the number of platelets was gradually decreased between the 7th and 14th days, it remained above 100,000/mm(3) for at least 12 mon ths in the nine patients, and above 20,000/mm(3) in the four patients. None of these 13 patients required hospitalization or therapy during the follow -up period. All of the patients tolerated the medication well. None of them reported side-effects that were severe enough to discontinue therapy. We c onclude that OMMP therapy is a safe, easy and effective therapy in children with refractory chronic ITP, and it may provide long-term remission in abo ut two thirds of the patients.