Assessing the impact of rituximab treatment on patient outcomes in idiopathic thrombocytopenic purpura

Background
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by increased platelet destruction and impaired platelet production. While high-dose dexamethasone (DXM) and other corticosteroids remain first-line therapy, many patients experience relapse or develop resistance.


Patients and methods
In this prospective study, 60 adult patients with ITP were randomized to receive DXM alone (n=20), low-dose rituximab (100 mg weekly for 4 weeks) plus DXM (n=20), or standard-dose rituximab (375 mg/m² weekly for 4 weeks) plus DXM (n=20). The primary endpoint was complete response rate (platelet count ≥100 × 10⁹/l) at week 24. Secondary endpoints included overall response at weeks 4 and 12, time to response, sustained response at 6 months, relapse rate, and safety profile.


Results

At week 24, complete response rates were significantly higher in both rituximab groups compared with DXM alone (low-dose: 55%, standard-dose: 65%, DXM alone: 10%;
P
<0.001). Median time to response was shorter in rituximab groups (low-dose: 8 days, standard-dose: 7 days, DXM alone: 12 days;
P
=0.008). Sustained response at 6 months was achieved in 60% of low-dose rituximab patients and 70% of standard-dose rituximab patients versus 30% with DXM alone (
P
=0.003).



Conclusion
Addition of rituximab to DXM significantly improves response rates and treatment durability in adult ITP patients compared with DXM alone. Low-dose rituximab shows comparable efficacy to standard-dose rituximab with a potentially improved safety profile, suggesting it may be a preferred treatment strategy, particularly in resource-limited settings.