The combination of low-dose rituximab and high-dose dexamethasone may be an effective first-line treatment for patients with newly diagnosed primary immune thrombocytopenia (ITP), according to a letter to the editor published in the European Journal of Haematology.

The letter was a follow-up to a previously published article from the same group describing their success using the combination of rituximab and dexamethasone. The update presents data from a new group of 17 patients who had the treatment initiated within 7 days of diagnosis.

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Twenty-eight days after the initiation of treatment, 10 of the 17 patients (58.8%) had a complete response (CR) with an overall response observed in 88.2%. By the third month of treatment, the CR rate had increased to 82.4% (n=15). After 6 months, 70.5% of the patients (n=12) had a sustained CR.

“We conclude that this early therapeutic combination as frontline therapy for adults with [newly diagnosed ITP] remains an attractive, viable, secure, and accessible option to achieve prolonged responses that could avoid chronicity,” the authors wrote.

A second cycle of dexamethasone was required for 2 patients before the 28th day after treatment initiation. Only 6 patients (35.5%) experienced relapse during follow-up, with a median time of 23.3 months from first response to therapy until relapse. Overall, the cumulative 12-month relapse-free survival rate was 83.4%, and the treatment-free survival rate was 68.1%.

The treatment was well tolerated, with only 3 patients experiencing grade 1 or 2 treatment-associated adverse effects. No infections were reported during the study period. The median follow-up for patients was 19.1 months (range, 3.5 to 76.8 months).

During the trial, all patients received 100 mg of rituximab within 7 days following diagnosis. Rituximab treatment was repeated weekly 3 more times. Dexamethasone was administered at a dose of 40 mg daily for the first 4 days.


Coronado-Alejandro EU, Martínez-Hernández JP, Gómez-De León A, et al. Low-dose rituximab plus high-dose dexamethasone in newly diagnosed immune thrombocytopenia. Eur J Haematol. Published online March 14, 2023. doi:10.1111/ejh.13954