Efficacy of oral versus intravenous steroids in the treatment of pediatric immune thrombocytopenic purpura: A single center experience

Objectives: This study conducted to assess the response rate to steroid in children with acute primary ITP and compare the relative effectiveness of oral steroid to intravenous dexamethasone.
Methods: A retrospective study involves children with primary ITP and treated by steroids with age below 15 years who were consulted the outpatient hematology clinic at central teaching hospital of pediatric from 1st of January 2024 to 31 December 2024. Patient were divided into two groups based on treatment modality: (1) children treated by oral prednisolone; (2) children treated by intravenous dexamethasone. For each patient recruited in the study, two set of data were collected: clinical data (presentation, severity of bleeding) , demographical data (age, gender), and laboratory data: which included platelets count that obtained from complete blood counts (baseline at presentation, on day 14th, and on day 28th of establishment of either mode of therapy).
Results: A total of 135 children diagnosed with primary ITP was treated by steroid with age range 2 months to 15 years. The severity of ITP was mild –moderate in 71% of patients and those was treated by oral prednisolone, while 29% were presented with severe bleeding and were treated by intravenous dexamethasone. The means of platelet count significantly elevated after the initiation of therapy in both oral prednisolone (P value = 0.03) and intravenous dexamethasone group (P value = 0.001) during 1st and 2nd evaluation. During the first evaluation, children on intravenous steroids show a significantly higher response than those treated by oral steroids P value = 0.001 and this difference maintained in the second evaluation visit with P value =0.021
Conclusion: Intravenous dexamethasone demonstrates greater efficacy than oral prednisolone in managing children with primary ITP, suggesting its preference as the optimal steroid regimen for treatment.