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It remains unclear whether and how obesity alters treatment outcomes in patients with primary immune thrombocytopenia (ITP). Thus, we retrospectively investigated 214 treatment\u2010na\u00efve patients who received standard high\u2010dose dexamethasone therapy in Qilu Hospital. Patients with obesity showed significantly lower overall initial response (underweight vs. normal vs. overweight vs. obese: 85.7% vs. 85.2% vs. 72.0% vs. 52.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and initial complete response ([CR], 71.4% vs. 70.4% vs. 53.3% vs. 27.3%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) rates. The same trend was observed in the 6\u2010month sustained response (63.6% vs. 52.3% vs. 35.6% vs. 22.7%, <jats:italic>p<\/jats:italic>\u2009=\u20090.03) and sustained CR (36.4% vs. 44.6% vs. 24.4% vs. 9.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). The Kaplan\u2013Meier analysis revealed a shortened duration of remission in the obese group (median duration of remission, not reached vs. 16\u2009months vs. 2\u2009months vs. 1\u2009month, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). In multivariate regression analysis, obesity was independently associated with poor initial and sustained responses, and an increased risk for relapse. In conclusion, obesity is a negative predictor for outcomes of corticosteroid treatment. A stratified strategy according to body mass index status may facilitate the precision management of ITP.<\/jats:p>","DOI":"10.1111\/bjh.18997","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T03:09:35Z","timestamp":1690254575000},"page":"295-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Obesity is associated with poor outcomes of corticosteroid treatment in patients with primary immune thrombocytopenia"],"prefix":"10.1111","volume":"203","author":[{"given":"Xiaoyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Hematology Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology Qilu Hospital of Shandong University  Jinan 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