Use of dapsone in chronic/refractory immune thrombocytopenic patients: A single center experience

Yıl 2023, Cilt: 5 Sayı: 2, 70 - 76, 29.04.2023

Ömer Candar , Vildan Ozkocaman , Tuba Ersal , Tuğçe Zor Turna , İbrahim Ethem Pınar , Cumali Yalçın , Bedrettin Orhan , Sinem Çubukçu , Tuba Güllü Koca , Rıdvan Ali , Fahir Özkalemkaş

https://doi.org/10.46310/tjim.1211506

Öz

Background: Dapsone is a second-line therapy for immune thrombocytopenia (ITP). It is cost-effective, with a response rate comparable to other drugs used as second-line therapy, such as azathioprine, danazol, cyclophosphamide, cyclosporine, vincristine, rituximab, and eltrombopag.
Material and Methods: This retrospective study analyzed ten adult patients who presented to our hematology division outpatient clinic between March 2013 and July 2021, was diagnosed with chronic/refractory ITP, did not respond to first-line therapy, and used dapsone.
Results: Eight (80%) patients were female, and 2 (20%) were male. The median age was 50 (range, 24-64) years. The mean pre-treatment platelet value was 12.8x109/L (range: 4-22.1x109/L). The median duration of symptoms before dapsone treatment was 60 (6-360) months. The median number of treatments received before dapsone was 4 (range: 3-6). All patients were routinely treated with oral dapsone 50 mg for two weeks, followed by 100 mg. The median time to treatment response was 39 (range: 14-90) days. The response rate was 60% (complete response 40%, partial response 20%). Asymptomatic anemia was observed as a side effect in only one patient.
Conclusions: Based on these results, it can be speculated that dapsone is an effective, inexpensive, and well tolerated
treatment option. Considering the economic status of developing countries, it seems very attractive
to use dapsone as the second-line therapy for chronic/refractory ITP. To the best of our knowledge, this is the
first study in Turkey on the use of dapsone for chronic/refractory ITP.

Anahtar Kelimeler

Dapsone, immune thrombocytopenia, thrombocytopenia

Destekleyen Kurum

uludag university medicine faculty

Kaynakça

• Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kühne T, Ruggeri M, George JN. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12;113(11):2386-93. doi: 10.1182/blood-2008-07-162503.
• George JN, Woolf SH, Raskob GE, Wasser JS, Aledort LM, Ballem PJ, Blanchette VS, Bussel JB, Cines DB, Kelton JG, Lichtin AE, McMillan R, Okerbloom JA, Regan DH, Warrier I. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996 Jul 1;88(1):3-40.
• Neunert CE. Current management of immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2013;2013:276-82. doi: 10.1182/asheducation-2013.1.276.
• Arnold DM. Second-line and subsequent therapies for immune thrombocytopenia (ITP) in adults. UpToDate 2023, Apr 21, 2022. Wolters Kluwer. https://www.uptodate.com/contents/second-line-and-subsequent-therapies-for-immune-thrombocytopenia-itp-in-adults. Accessed on 14 September 2022.
• Godeau B, Oksenhendler E, Bierling P. Dapsone for autoimmune thrombocytopenic purpura. Am J Hematol. 1993 Sep;44(1):70-2. doi: 10.1002/ajh.2830440117.
• Godeau B, Durand JM, Roudot-Thoraval F, Tennezé A, Oksenhendler E, Kaplanski G, Schaeffer A, Bierling P. Dapsone for chronic autoimmune thrombocytopenic purpura: a report of 66 cases. Br J Haematol. 1997 May;97(2):336-9. doi: 10.1046/j.1365-2141.1997.412687.x.
• Dutta TK, Goel A, Ghotekar LH, Hamide A, Badhe BA, Basu D. Dapsone in treatment of chronic idiopathic thrombocytopenic purpura in adults. J Assoc Physicians India. 2001 Apr;49:421-5.
• Hill QA. How does dapsone work in immune thrombocytopenia? Implications for dosing. Blood. 2015 Jun 4;125(23):3666-8. doi: 10.1182/blood-2015-03-632000.
• Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, Chong BH, Cines DB, Gernsheimer TB, Godeau B, Grainger J, Greer I, Hunt BJ, Imbach PA, Lyons G, McMillan R, Rodeghiero F, Sanz MA, Tarantino M, Watson S, Young J, Kuter DJ. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168-86. doi: 10.1182/blood-2009-06-225565.
• Patel AP, Patil AS. Dapsone for immune thrombocytopenic purpura in children and adults. Platelets. 2015;26(2):164-7. doi: 10.3109/09537104.2014.886677.
• Zaja F, Marin L, Chiozzotto M, Puglisi S, Volpetti S, Fanin R. Dapsone salvage therapy for adult patients with immune thrombocytopenia relapsed or refractory to steroid and rituximab. Am J Hematol. 2012 Mar;87(3):321-3. doi: 10.1002/ajh.22266.
• Varghese L, Viswabandya A, Mathew AJ. Dapsone, danazol, and intrapartum splenectomy in refractory ITP complicating pregnancy. Indian J Med Sci. 2008 Nov;62(11):452-5.
• Damodar S, Viswabandya A, George B, Mathews V, Chandy M, Srivastava A. Dapsone for chronic idiopathic thrombocytopenic purpura in children and adults--a report on 90 patients. Eur J Haematol. 2005 Oct;75(4):328-31. doi: 10.1111/j.1600-0609.2005.00545.x.
• Colella MP, Orsi FA, Alves ECF, Delmoro GF, Yamaguti-Hayakawa GG, de Paula EV, Annichino-Bizzacchi JM. A retrospective analysis of 122 immune thrombocytopenia patients treated with dapsone: Efficacy, safety and factors associated with treatment response. J Thromb Haemost. 2021 Sep;19(9):2275-2286. doi: 10.1111/jth.15396.
• Lee JY, Lee JO, Jung JY, Bang SM. Dapsone therapy for refractory immune thrombocytopenia patients: a case series. Blood Res. 2017 Jun;52(2):95-9. doi: 10.5045/br.2017.52.2.95.
• Rattanathammethee T, Theerajangkhaphichai W, Rattarittamrong E, Hantrakool S, Chai-Adisaksopha C, Norasetthada L, Tantiworawit A. The efficacy of colchicine and dapsone combination therapy in relapsed immune thrombocytopenia. Hematol Rep. 2017 Feb 23;9(1):7034. doi: 10.4081/hr.2017.7034.
• Hernández F, Linares M, Colomina P, Pastor E, Cerveró A, Pérez A, Perella M. Dapsone for refractory chronic idiopathic thrombocytopenic purpura. Br J Haematol. 1995 Jun;90(2):473-5. doi: 10.1111/j.1365-2141.1995.tb05179.x.
• Vancine-Califani SM, De Paula EV, Ozelo MC, Orsi FL, Fabri DR, Annichino-Bizzacchi JM. Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura. Platelets. 2008 Nov;19(7):489-95. doi: 10.1080/09537100802315110.