A new study published in the British Journal of Haematology identified 6 factors associated with poor response to corticosteroid therapy in patients with immune thrombocytopenia (ITP).

These factors included age over 80 years, a platelet count below 9×109/L, platelet-associated immunoglobulin G levels of 445 ng per 107 cells or higher, a platelet distribution width of 14 g/dL or higher, a lymphocyte-to-monocyte ratio of 3.52 or higher, and a megakaryocyte count in the bone marrow lower than 85.5/μL. 

Read more about the treatment of ITP

“These six factors are likely to be useful biomarkers for predicting corticosteroid response in these patients,” the authors of the study said. “Physicians should consider early initiation of second-line treatment . . . when patients with ITP show any of these six significant disease characteristics.”

Corticosteroids are often used as first-line treatment in patients with ITP.

While some patients have a favorable response to this treatment, others have a poor response. 

To be able to predict patient response to corticosteroid treatment, a team of researchers from the Department of Hematology at Shinko Hospital in Kobe, Japan led by Nobuyoshi Arima, MD, PhD, conducted a single-center, retrospective, cohort study in 127 patients with ITP. All patients were treated with corticosteroids as first-line therapy. 

Of these, 68 (53.5%) had a favorable response to treatment, while 59 (46.5%) had a poor response. 

The factors that were predictive of poor response were identified after many characteristics and test results were compared between the responders and nonresponders. 

ITP is an autoimmune bleeding disorder characterized by very low platelet counts. It is the result of the immune system mistakenly attacking platelets, causing their destruction. This leads to mucosal bleeding and bruising, among other symptoms.

Corticosteroids are used to reduce the rate of platelet destruction, promote primary hemostasis, and reduce bleeding.


Nakamura N, Tsunemine H, Sakai T, Arima N. Biomarkers for predicting response to corticosteroid therapy for immune thrombocytopenic purpura. Br J Haematol. Published online January 28, 2023. doi:10.1111/bjh.18670