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.