Comparison of AZA plus Prednisone vs Prednisone Alone as Initial Treatment for Antinuclear Antibody-Positive Immune Thrombocytopenia

May 17, 2023

The following is a summary of “Efficacy and safety of azathioprine plus prednisone versus prednison e alone as first-line treatment for antinuclear antibody-positive immune thrombocytopenia: a retrospective cohort study,” published in the April 2023 issue of Hematology by Su, et al.

For a study, researchers sought to compare the effectiveness and safety of AZA plus prednisone and prednisone alone as first-line treatments in ANA-positive ITP patients, who typically have a poorer prognosis and poorer response to first-line glucocorticoids (GCs).

A total of 18 ANA-positive ITP patients received prednisone alone as their first-line treatment, whereas 15 ANA-positive ITP patients received AZA plus prednisone (AZA + GC group) and 15 ANA-positive ITP patients received AZA plus prednisone (AZA + GC group).

The AZA + GC group showed a higher complete response (CR) rate (60.0% versus 22.2%) (P = 0.038) compared to the GC group, while the overall response rate (86.7% versus 55.6%) (P = 0.070) showed an increasing trend but was not statistically significant. Multivariate analysis demonstrated that AZA + GC (versus GC) (odds ratio = 31.331, P = 0.018) was independently associated with a higher possibility of achieving CR. Furthermore, the AZA + GC group showed a longer accumulating relapse-free duration (median: 7.8 months vs. 3.4 months) (P = 0.038), and multivariate analysis showed that AZA + GC (versus GC) (hazard ratio = 0.306, P = 0.007) was independently correlated with longer accumulating relapse-free duration. The frequency of adverse events was similar in the two groups (all P > 0.05), with the AZA + GC group experiencing more pneumonia (13.3%), anemia (13.3%), cough (13.3%), nausea (6.7%), and granulocytopenia (6.7%), all of which were bearable and managed.

First-line AZA plus prednisone treatment led to better hematological responses and longer relapse-free durations with acceptable adverse events compared to prednisone alone in ANA-positive ITP patients.

Reference: https://www.tandfonline.com/doi/full/10.1080/16078454.2023.2196864