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Ideally initial treatment would not just increase the platelet count but also provide a long\u2010term sustained remission. While many clinicians use prednisone (PDN) as their first choice of corticosteroid, others prefer dexamethasone. The controversy is the subject of debates. Short courses of higher\u2010dose corticosteroids were first reported by the Andersen study in 1994. The study posited high\u2010dose dexamethasone as a \u2018cure\u2019 for all ITP patients. Later, studies addressed the number of dexamethasone cycles, indications to repeat cycles and timing between cycles, with varied long\u2010term results. The results with dexamethasone were compared to PDN in some studies: the four\u2010day cycles of dexamethasone work faster in increasing platelet counts and appear to reduce the occurrence of severe adverse events. Therefore, it is probably a better option for patients with low platelet counts and bleeding diathesis; however, curative superiority, the initial reason to administer it, compared to PDN is not well demonstrated. Across the studies, treatment with high\u2010dose dexamethasone seems to be safer, with lower incidence of all adverse events compared to PDN, which might be a reflection of shorter treatment duration and possibly also lower cumulative steroid dose. Dexamethasone in combination with rituximab in first\u2010line treatment produced higher response rates with better long\u2010term results compared to high\u2010dose dexamethasone alone and is a particularly good option in younger women.<\/jats:p>","DOI":"10.1111\/bjh.18398","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T03:48:11Z","timestamp":1659584891000},"page":"15-22","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Should dexamethasone alone or in combination be the initial steroid for adult ITP: Still a relevant question"],"prefix":"10.1111","volume":"200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8836-0091","authenticated-orcid":false,"given":"Barbara","family":"Skopec","sequence":"first","affiliation":[{"name":"Department of Hematology University Medical Center Ljubljana  Ljubljana Slovenia"},{"name":"Medical Faculty University of Ljubljana  Ljubljana 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