Two cohort studies have provided additional guidance if clinicians choose to use shorter courses of corticosteroids. Mazzucconi and colleagues108 summarize 2 cohort studies that demonstrated high response rates with repeated short courses of dexamethasone, and Cheng et al104 summarize an additional cohort study of high-dose dexamethasone. Both studies report high rates of sustained response. The study by Mazzucconi et al reported in the monocenter cohort an overall relapse-free survival, defined as a platelet count > 20 109/L, in responders to dexamethasone to be 90% (95% CI 78.3-100) at 15 months. Similar results were found in the multicenter cohort, which demonstrated an overall relapse-free survival of 81% (95% CI 70.6-92.3) using a slightly higher platelet count of 30 109/L to define response. The investigation by Cheng et al found that 42% of all treated patients had a platelet count > 50 109/L at 6 months and required no further treatment during a 2- to 5-year follow-up period. Neither of these investigations has a comparator, however, making the relative efficacy compared with other treatments difficult to evaluate.
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