Keywords

1. Pediatric Chronic ITP
2. Dapsone Treatment ITP
3. Immune Thrombocytopenia
4. ITP Therapy Children
5. Second-Line ITP Agents

Recent findings from a tertiary center in South India shed light on the efficacy of dapsone, a drug with a previously established but limited usage profile, in the treatment of pediatric chronic immune thrombocytopenia (ITP). Chronic ITP is a condition characterized by an abnormally low platelet count, leading to an increased risk of bleeding, and is considered chronic when symptoms persist beyond 12 months. Though ITP commonly resolves within 3-12 months, 10%-20% of patients progress to have the chronic form that necessitates treatment intervention.

The study, detailed in the “British Journal of Haematology” and authored by a team of pediatric hematologists from St John’s Medical College Hospital and the St Johns Research Institute in Bengaluru, Karnataka, India, brings hope to individuals grappling with chronic ITP. The culmination of 5 years of observation and research, their publication offers essential insights into a population that frequently faces limited options and significant challenges.

The observational study, spread out from January 2012 to December 2017, tracked the medical journeys of 103 children diagnosed with chronic ITP. Exclusively, 45 children, 17 boys and 28 girls, met the stringent inclusion criteria to receive dapsone as a second-line agent following lack of adequate response to initial treatments. The study’s demographics reflect a prevalence of the condition across gender lines, with a higher representation of girls at 62.2%. Early response to dapsone therapy was registered in 37.8% of the cohort, providing initial optimism about this treatment path. Over a median follow-up period of 50 months, a significant 64.4% exhibited at least a partial response, showcasing the potential for dapsone to induce sustained remission in pediatric patients dealing with chronic ITP.

The use of dapsone, an antibiotic commonly used in the treatment of dermatitis herpetiformis, leprosy, and as prophylaxis against Pneumocystis carinii pneumonia in immunocompromised patients, marks an innovative approach in managing chronic ITP, particularly for treatments that have not yielded the desired outcomes.

Dapsone’s history in treating other immunologically mediated conditions, such as autoimmune bullous diseases, sets the precedent for its mechanism of action in ITP. The authors of the study contribute to a growing body of evidence advocating for the drug’s role in pediatric care, complemented by previous research that has explored its potential in adult cases of ITP.

The significant impact highlighted in this short report aligns with the conclusions drawn by other researchers in the past. Durand et al. (1991) and Damodar et al. (2005) backed dapsone’s efficacy in treating adult patients with ITP, while a 2011 publication by Piette and Werth illuminated its utility in autoimmunity disorders. As the scientific community delves deeper into the pathogenesis of ITP and potential therapeutic options, dapsone’s immune-modulating abilities, delineated in studies by Hill (2015) and Patel and Patil (2015), capture clinician interest.

In comparing the South Indian cohort’s results with second-line therapies like eltrombopag, the findings similarly reflect a promising survival curve and underscore the nuanced approach required in managing pediatric chronic ITP distinctively. The international focus on ITP treatment is growing, as demonstrated by recent guidelines laid out by the American Society of Hematology, which recognizes the necessity for individualized management strategies.

This study, relying on observational data, paves the way for further controlled trials to ascertain dapsone’s role in pediatric ITP management and dosing concerns. Clinicians may look into the thoughtful use of dapsone, alongside other therapeutic avenues, which entails weighing the medication’s benefits against potential hemolytic side effects and methemoglobinemia, especially in patients with glucose-6-phosphate dehydrogenase deficiency.

Reference Link: https://doi.org/10.1111/bjh.19277

References

1. Anoop P. (2012). Immune thrombocytopenic purpura: historical perspective, current status, recent advances and future directions. Indian Pediatr., 49(10), 811-818.
2. Neunert C., Terrell D.R., Arnold D.M., Buchanan G., Cines D.B., Cooper N., et al. (2019). American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv., 3(23), 3829-3866.
3. Schifferli A., Holbro A., Chitlur M., Coslovsky M., Imbach P., Donato H., et al. (2018). A comparative prospective observational study of children and adults with immune thrombocytopenia: 2-year follow-up. Am J Hematol., 93(6), 751-759.
4. Maltezou H.C., Petropoulos D., Choroszy M., Gardner M., Mantzouranis E.C., Rolston K.V., et al. (1997). Dapsone for Pneumocystis carinii prophylaxis in children undergoing bone marrow transplantation. Bone Marrow Transplant., 20(10), 879-881.
5. Piette E.W., Werth V.P. (2011). Dapsone in the management of the autoimmune bullous diseases. Dermatol Clin., 29(4), 561-564.
6. Durand J.M., Lefèvre P., Hovette P., Mongin M., Soubeyrand J. (1991). Dapsone for idiopathic autoimmune thrombocytopenic purpura in elderly patients. Br J Haematol., 78(3), 459-460.
7. Hill Q.A. (2015). How does dapsone work in immune thrombocytopenia? Implications for dosing. Blood., 125(23), 3666-3668.
8. Damodar S., Viswabandya A., George B., Mathews V., Chandy M., Srivastava A. (2005). Dapsone for chronic idiopathic thrombocytopenic purpura in children and adults – a report on 90 patients. Eur J Haematol., 75(4), 328-331.
9. Evim M.S., Baytan B., Güneş A.M. (2014). Childhood immune thrombocytopenia: long-term follow-up data evaluated by the criteria of the international working group on immune thrombocytopenic purpura. Turk J Haematol., 31(1), 32-39.
10. Grainger J.D., Locatelli F., Chotsampancharoen T., Donyush E., Pongtanakul B., Komvilaisak P., et al. (2015). Eltrombopag for children with chronic immune thrombocytopenia (PETIT2): a randomised, multicentre, placebo-controlled trial. Lancet., 386(10004), 1649-1658. https://doi.org/10.1016/S0140-6736(15)61107-2. Erratum in: Lancet. 2015;386(10004):1630.
11. Johnsen J. (2012). Pathogenesis in immune thrombocytopenia: new insights. Hematology Am Soc Hematol Educ Program., 2012, 306-312.
12. Patel A.P., Patil A.S. (2015). Dapsone for immune thrombocytopenic purpura in children and adults. Platelets., 26(2), 164-167.
13. Vancine-Califani S.M.C., De Paula E.V., Ozelo M.C., Orsi F.L.A., Fabri D.R., Annichino-Bizzacchi J.M. (2008). Efficacy and safety of dapsone as a second-line treatment in non-splenectomized adults with immune thrombocytopenic purpura. Platelets., 19(7), 489-495.
14. Zaja F., Marin L., Chiozzotto M., Puglisi S., Volpetti S., Fanin R. (2012). Dapsone salvage therapy for adult patients with immune thrombocytopenia relapsed or refractory to steroid and rituximab. Am J Hematol., 87(3), 321-323.

Note: This article is based on previously published studies and does not contain any new results. It’s important to ensure that the usage of dapsone follows current medical guidelines and to consult with healthcare professionals for potential side effects and appropriateness for pediatric patients.