Dapsone is recommended as a second line therapy in immune thrombocytopenia ITP , but is underused because of its potential side effects. The overall response rate was Patients with complete response had shorter disease duration whereas no difference was observed between responders and non-responders regarding age, sex or previous treatments received. Side effects resolved in all but one case. Overall, these data support dapsone as an interesting second line therapy in ITP, with a good safety and efficacy profile at a low cost.
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Data Availability: The data set has been summarized in a table that has been uploaded as a supporting information file. Competing interests: The authors have declared that no competing interests exist. Immune thrombocytopenia ITP is an autoimmune disorder leading to a low platelet count responsible for bleedings of variable severity. Steroids are used as first-line therapy, while intravenous immunoglobulins IVIg should be restricted to patients with severe bleeding symptoms [ 1 β 3 ].
Both steroids and IVIg offer high response rates, but relapses are common [ 1 , 2 ]. Of note, rituximab is expensive and could favour infections [ 7 ]. Because of its side-effects, particularly virilization and liver cytolysis, danazol is less and less used [ 9 , 10 ]. Of note, long term infectious susceptibility following splenectomy requires prophylactic measures and patient education. Immunosuppressive drugs such as azathioprine, ciclosporine, cyclophosphamide or mycophenolate mofetil are dedicated to multirefractory patients [ 19 ].
The mechanisms of action of dapsone remain unclear, but it has been postulated that haemolysis induced by dapsone might limit the phagocytosis of opsonized-platelets by diverting splenic macrophages [ 20 , 23 ].
