***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Immune thrombocytopenia ( ITP ) is an immune disorder commonly presents as isolated thrombocytopenia . Generally corticosteroids are the main treatment of ITP . This study was design ed to evaluate effectiveness of high dose dexamethasone comparing conventional corticosteroid therapy in the treatment of ITP . Material s and methods In a r and omized prospect i ve study , sixty adult patients with newly diagnosed primary symptomatic ITP ( Platelet count < 20,000 ) were evaluated . Patients divided into two groups . In group A , thirty patients ( mean age of 24.9 years ) received Dexamethasone 40 mg/IV/daily for four days ( 10 mg/q6h ) ; and then Prednisolone 1 mg/kg/day/PO with rapid tapering of prednisolone ( 10 mg/week ) . From the other h and , in group B , thirty patients ( mean age of 27.2 years ) were treated with Prednisolone 1 mg/kg/day/PO for four weeks , then the drug tapered weekly . Results All the patients in group A showed favorable response within the first seven days , 27 cases presented complete response ( CR ) and three cases revealed response ( R ) . In group B , 11 cases had CR , 13 cases showed R and six cases had No response ( NR ) . After three months , rates of CR were 80 % and 23.3 % in group A and B ; respectively . Responses were 16.7 % and 33.3 % , NRs were 6.6 % and 43.3 % in group A and B ; respectively ( P < 0.0001 ) . After 6 months , CR was 73.3 % vs.16.7 % , and R was 16.7 % vs.36.7 % and NR was 10 % vs. 46.7 % in group A and B ; respectively ( P < 0.0001 ) . After 12 months , there was no change in response rate in group A , but in group B 53 % were non responsive , 40 % showed R ( chronic ITP ) and complete response was observed only in 6.7 % ( P < 0.0001 ) . Three cases in group A and 12 cases in group B had needed splenectomy ( P < 0.00002 ) . Conclusion We showed that high dose dexamethasone is more effective than conventional steroid therapy in newly diagnosed ITP as initial treatment with less relapses and toxicities We report the results of a r and omized clinical trial of two different coricosteroids ( prednisone versus deflazacort ) in patients affected by autoimmune thrombocytopenic purpura ( ATP ) . We have evaluated the efficacy of the two steroids on platelet count , antiplatelet antibodies , lymphocyte subsets and the occurrence of side effects .  Twenty-seven patients were evaluable : 13 were treated with PDN and 14 with DFC .  After 24 weeks of treatment , 4/12 ( 33 % ) , subjects treated with PDN were refractory while complete responses were obtained in 2/12 ( 17 % ) and partial responses in 6/12 ( 50 % ) . Among patients treated with DFC , 4/11 ( 36 % ) were considered as refractory , 2/11 ( 18 % ) had a complete response and 5/11 ( 46 % ) a partial response . A statistically significant decrease of antiplatelet antibodies was recorded in both groups after 4 weeks of therapy , but only in subjects receiving PDN did the reduction last until the 24th week . We observed an increase of T lymphocyte subsets ( CD3 , CD2 , CD4 , CD8 ) in absolute number , due to an increase in circulating lymphocytes , after 4 weeks . No substantial modifications were observed in these population s regarding the percentage or the CD4/CD8 ratio . After 24 weeks , 91 % ( 10/11 ) of patients treated with PDN presented an increase of body weight and 1 had a stable increase in blood pressure . Among the subjects treated with DFC , 64 % ( 7/11 ) showed an increase of body weight after the same follow-up . In conclusion , no difference was observed the two steroids studied In idiopathic thrombocytopenic purpura ( ITP ) , corticosteroids have been widely recognized as the most appropriate first-line treatment , even if the best therapeutic approach is still a matter of debate . Recently , a single high-dose dexamethasone ( HD-DXM ) course was administered as first-line therapy in adult patients with ITP . In this paper we show the results of 2 prospect i ve pilot studies ( monocentric and multicentric , respectively ) concerning the use of repeated pulses of HD-DXM in untreated ITP patients . In the monocenter study , 37 patients with severe ITP , age at least 20 years and no more than 65 years , were enrolled .  HD-DXM was given in 4-day pulses every 28 days , for 6 cycles . Response rate was 89.2 % ; relapse-free survival ( RFS ) was 90 % at 15 months ; long-term responses , lasting for a median time of 26 months ( range 6 - 77 months ) were 25 of 37 ( 67.6 % ) . In the multicenter study , 95 patients with severe ITP , age at least 2 years and no more than 70 years , were enrolled .  HD-DXM was given in 4-day pulses every 14 days , for 4 cycles ; 90 patients completed 4 cycles . Response rate ( 85.6 % ) was similar in patients classified by age ( < 18 years , 36 of 42=85.7 % ; > or=18 years , 41 of 48=85.4 % , P = not significant ) , with a statistically significant difference between the second and third cycle ( 75.8 % vs 89 % , P=.018 ) . RFS at 15 months 81 % ; long-term responses , lasting for a median time of 8 months ( range 4 - 24 months ) were 67 of 90 ( 74.4 % ) . In both studies , therapy was well tolerated . A schedule of 3 cycles of HD-DXM pulses will be compared with st and ard prednisone therapy ( eg , 1 mg/kg per day ) in the next r and omized Gruppo Italiano Malattie EMatologiche dell'Adulto ( GIMEMA ) trial BACKGROUND Treatment of adults with autoimmune thrombocytopenic purpura ( AITP ) is based more on individual experience than on results of controlled studies . We compared intravenous immunoglobulin with high-dose methylprednisolone in untreated adults with severe AITP and assessed efficacy of subsequent oral steroids compared with placebo . Primary outcome was number of days with platelet count greater than 50 x 10(9)/L within the first 21 days . METHODS We did a r and omised multicentre trial based on a 232 design . 122 adults with severe AITP ( platelet count < or = 20 x 10(9)/L ) were r and omly assigned to receive either intravenous immunoglobulin or high-dose methylprednisolone on days 1 - 3 ( r and omisation A ) , and then to receive either oral prednisone or placebo ( r and omisation B ) on days 4 - 21 . Analysis was by intention to treat . FINDINGS Six patients were excluded from the analysis . The number of days on which platelet counts were above 50 x 10(9)/L was 18 in 56 patients receiving intravenous immunoglobulin and 14 in 60 receiving high-dose methylprednisolone ( p=0.02 ) . Percentage of patients who had platelet counts over 50 x 10(9)/L on days 2 and 5 was 7 % and 79 % , respectively , in the intravenous immunoglobulin group compared with 2 % and 60 % , respectively , in the high-dose methylprednisolone group ( p=0.04 ) . During the second treatment period , prednisone was more effective than placebo for all short-term endpoints . Patients who received intravenous immunoglobulin and prednisone had platelet count greater than 50 x 10(9)/L for 18.5 days ( p=0.005 ) , and those treated with high-dose methylprednisolone and prednisone had this count for 17.5 days . INTERPRETATION Intravenous immunoglobulin and oral prednisone seems to be more effective than high-dose methylprednisolone and oral prednisone in adults with severe AITP , although the latter treatment is effective and well tolerated Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background T-cell dysregulation and T-cell-related cytokine abnormalities are involved in the pathogenesis of immune thrombocytopenia ( ITP ) . One of our previous studies showed that elevated IL-22 correlated to Th1 and Th22 cells plays an important role in the immunopathogenesis of ITP . In this study , we aim ed to investigate the effects of high-dose dexamethasone ( HD-DXM ) on IL-22 production and on the IL-22-producing T-cell subsets in ITP patients . Methods IL-22 plasma levels and the percentages of Th1 , Th17 , and Th22 cells were determined by enzyme-linked immunosorbent assay and flow cytometry in 25 ITP patients receiving DXM 40 mg/day for 4 consecutive days . Results Plasma IL-22 concentrations and the percentages of Th1 and Th22 cells were significantly increased in pre-therapy patients relative to controls ( P < 0.05 ) , but the percentage of Th17 cells was not . HD-DXM administration reduced IL-22 production and corrected the imbalance between Th1 and Th22 subsets . IL-22 levels were positively correlated with Th1 and Th22 cells in ITP patients before and after HD-DXM treatment . Conclusion These results suggest that HD-DXM may regulate the production of IL-22 in ITP , possibly by correcting Th1 and Th22 polarization This study compared the efficacy and safety of high-dose dexamethasone ( HD-DXM ) and conventional prednisone ( PDN ) on the largest cohort to date as first-line strategies for newly diagnosed adult primary immune thrombocytopenia ( ITP ) . Patients enrolled were r and omized to receive DXM 40 mg/d for 4 days ( n = 95 , nonresponders received an additional 4-day course of DXM ) or prednisone 1.0 mg/kg daily for 4 weeks and then tapered ( n = 97 ) . One or 2 courses of HD-DXM result ed in a higher incidence of overall initial response ( 82.1 % vs 67.4 % , P = .044 ) and complete response ( 50.5 % vs 26.8 % , P = .001 ) compared with prednisone . Time to response was shorter in the HD-DXM arm ( P < .001 ) , and a baseline bleeding score ≥8 was associated with a decreased likelihood of initial response . Sustained response was achieved by 40.0 % of patients in the HD-DXM arm and 41.2 % in the PDN arm ( P = .884 ) . Initial complete response was a positive indicator of sustained response , whereas presence of antiplatelet autoantibodies was a negative indicator . HD-DXM was generally tolerated better . We concluded that HD-DXM could be a preferred corticosteroid strategy for first-line management of adult primary ITP . This study is registered at www . clinical trials.gov as # NCT01356511 Background : To tackle the problems associated with high-dose dexamethasone ( HD-DXM ) in patients with immune thrombocytopenia ( ITP ) . Aim : To compare the efficacy of HD-DXM with or without low-dose dexamethasone maintenance in untreated ITP patients . Results : Dexamethasone ( 40 mg/day ) was given in 4-day pulses every 14 days for 3 cycles in 61 patients with ITP . Among them , 30 cases were given dexamethasone ( 0.035 mg/kg per day ) for maintenance between pulsed HD-DXM and after 3 HD-DXM courses ( HD-DXM-M group ) and another 31 cases did not receive dexamethasone maintenance ( HD-DXM-nM group ) . The control group comprised the patients who received prednisone ( prednisone group ) . The following results were obtained : ( 1 ) at the end of the 3rd cycle , the overall response rate ( ORR ) was higher in the HD-DXM group than in the prednisone group ; ( 2 ) the ORR of the HD-DXM group peaked after the 3rd cycle ; ( 3 ) the ORR after each course was higher in the HD-DXM-M group than in the HD-DXM-nM group ; ( 4 ) in the 12th month after HD-DXM discontinuation , the relapse rate of the HD-DXM-M group was lower than that of the other groups ( prednisone and HD-DXM-nM ) . Conclusion : Treatment with 3 cycles of HD-DXM pulses with low-dose dexamethasone maintenance is an 
    Output:
    
No difference in initial platelet count response was observed with different high-dose corticosteroid regimens in children .
INTERPRETATION In adults with previously untreated immune thrombocytopenia  , high-dose dexamethasone did not improve durable platelet count responses compared with st and ard-dose prednisone .