Patients with obesity and primary immune thrombocytopenia (ITP) appear to have an impaired response to corticosteroid therapy, a shorter remission period, and a higher risk of relapse than patients who are not obese, according to a study published in the British Journal of Haematology.

Overall initial response to high-dose dexamethasone was significantly lower in patients with obesity compared to those in other weight categories (P =.001). Patients in the obese category had a 52.3% initial response rate, compared to 85.7% for underweight, 85.2% for normal-weight, and 72.0% for overweight patients.

Initial complete response (CR) rates were also significantly lower for patients in the obese category (27.3%) compared to the other categories (underweight vs normal-weight vs overweight; 71.4% vs 70.4% vs 53.3%).

Sustained response and CR rates were also significantly lower for patients with obesity than the other patient groups (P =.03 and P =.01, respectively). Having an obese body mass index (BMI) also significantly increased relapse rates (P =.02) and reduced the duration of remission (P =.002).

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Multivariate analyses found that obesity was independently associated with an impaired initial response when adjustments were made for age, gender, and bleeding score (adjusted odds ratio [aOR], .19; 95% CI, .08-.46; P <.001).

Further adjustment to the model for infection and metabolism risk factors still showed a significant risk of impaired initial response (P =.001). Obesity also predicted a reduced likelihood of achieving a sustained response (P =.02) and an increased risk of relapse (P =.003) using multivariate models.

“These findings suggest that obesity is a negative predictor in ITP patients receiving corticosteroid therapy. To our knowledge, this is the first cohort study on the relationship between obesity and the treatment outcomes of ITP,” the authors wrote.

A total of 214 patients with ITP were included in the study from the Qilu Hospital of Shandong University, Jinan, China, including 14 patients who were underweight, 81 patients with normal weight, 75 patients who were overweight, and 44 patients with obestiy. An initial response was observed in 158 patients (73.8%) with a CR being observed in 119 patients (55.6%). The mean follow-up duration was 73 months.


Zhang X, Liu Q, Liu A, et al. Obesity is associated with poor outcomes of corticosteroid treatment in patients with primary immune thrombocytopenia. Br J Haematol. Published online July 24, 2023. doi:10.1111/bjh.18997