Danazol therapy for immune thrombocytopenic purpura

Immune thrombocytopenic purpura, a fairly common condition in children, is usually benign and self-limited, resolving spontaneously within a few months. Patients with significant bleeding usually respond to steroid therapy. Many types of therapy are recommended for chronic thrombocytopenic purpura, including steroids, splenectomy, immunosuppressive agents, vincristine and high-dose intravenous gamma globulin.

Weinblatt and associates report their experience with danazol, an attenuated androgen, in ten symptomatic children with refractory immune thrombocytopenic purpura. The patients ranged in age from 30 months to 17 years. All were initially treated with prednisone and either had a poor response to therapy or became steroid-dependent, with hemorrhagic symptoms occurring when steroid doses were reduced. Other methods of treatment, including high-dose intravenous gamma globulin, azathioprine, splenectomy or plasmapheresis, had been tried in some of the children but failed to raise the platelet counts.

Danazol therapy was begun at a dosage of 20 to 30 mg per kg per day in divided doses and was increased up to a maximum of 800 mg per day in older children. Nine of the ten patients exhibited improvement in platelet counts following danazol therapy. Response times varied from one week to one month. Steroid therapy could be withdrawn in most of the patients who had been receiving concomitant steroids. No liver function abnormalities or other significant adverse effects were associated with the use of danazol. (American Journal of Diseases of Children, December 1988, vol. 142, p. 1317.)

COPYRIGHT 1989 American Academy of Family Physicians
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