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首页> 外文期刊>Platelets >Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura.
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Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura.

机译：氨苯砜作为二线治疗非脾脏切除的成人免疫性血小板减少性紫癜的疗效和安全性。

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In adults with immune thrombocytopenic purpura (ITP), steroids are usually proposed as first-line therapy, but long-term complete responses are obtained in no more than 20% of patients. For the remaining patients, splenectomy is considered the treatment of choice, with reported "cure" rates from 60-70%. However, the inherent risks of surgery and sepsis after splenectomy without a guarantee of success justify the search for strategies aimed to avoid splenectomy. Here we retrospectively evaluated the results of dapsone treatment in ITP patients that failed first-line therapy with steroids. These patients received dapsone 100 mg/day for a minimum of 30 days before splenectomy was considered. Efficacy was defined as a sustained rise in platelet counts (>50 x 10(9)/l) clearly attributed to dapsone treatment. Among 52 steroid-dependent or refractory patients, dapsone resulted in sustained increases in platelet counts in 44.2% of patients, after a median follow-up of 21.10 months after treatment initiation. The long-term efficacy of dapsone in this setting is further corroborated by the observation that none of the "responding" patients required splenectomy in the follow-up, compared to 69.0% of the "non-responding" patients. Dapsone-related adverse events were mild and promptly reversed by treatment withdrawal. The results of our retrospective analysis suggest that dapsone is a safe and effective second-line agent for steroid-dependent or refractory ITP patients. Because of its well-known safety profile and low cost compared to other potential second-line treatments for ITP, a trial course of dapsone should be viewed as an attractive option before splenectomy in steroid-dependent of refractory adult ITP patients.
机译：在患有免疫性血小板减少性紫癜（ITP）的成人中，通常建议将类固醇作为一线治疗，但在不超过20％的患者中可获得长期的完全缓解。对于其余患者，脾切除术被认为是首选治疗方法，据报道“治愈”率在60-70％之间。但是，脾切除术后固有的手术风险和败血症不能保证成功，因此寻求避免脾切除的策略是合理的。在这里，我们回顾性评估了在一线类固醇激素治疗失败的ITP患者中氨苯砜治疗的结果。在考虑行脾切除术之前，这些患者接受氨苯砜100 mg /天的治疗至少持续30天。疗效定义为氨苯砜治疗后血小板计数持续升高（> 50 x 10（9）/ l）。在开始治疗的中位随访时间为21.10个月之后，在52位激素依赖或难治性患者中，氨苯砜导致44.2％的患者血小板计数持续增加。氨苯砜在这种情况下的长期疗效通过以下观察得到了进一步的证实：“随访”中没有“响应”患者不需要脾切除术，而“无响应”患者中没有进行脾切除术的比例为69.0％。氨苯砜相关的不良事件较轻，停药后迅速逆转。我们的回顾性分析结果表明，氨苯砜对于激素依赖型或难治性ITP患者是安全有效的二线药物。由于其众所周知的安全性和与其他可能的ITP二线治疗相比较低的成本，因此在进行类固醇依赖的难治性ITP成人脾切除术之前，应将氨苯砜的试用期视为一项有吸引力的选择。

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