Background and aims Primary immune thrombocytopenia (ITP) is characterised by accelerated platelet destruction. Corticosteroids have been shown to increase platelet counts. The objective of our study was to compare the treatment with prednisolone at a dose of 4 mg / kg / day for 4 days (Protocol P1) to the treatment with prednisolone at the dose of 2 mg / kg / day for 6–8 weeks (Protocol P2).

Methods We conducted a comparative analytical study between 2 groups: first group (G1) formed by ITP cases followed prospectively between 2010 and 2013. These patients received protocol P1. The second group (G2) collecting the same number of patients followed retrospectively between 1999 and 2008. These patients received protocol P2.

Results Our study included 24 cases: 12 cases in G1 and 12 cases in G2. The response on day three was 25% for G1 and 0% for G2. The response on the fifth day was 66.7% (G1) and 54.5% (G2). The median time to response was 5 days for the 2 groups, with extremes ranging from 3 to 30 days (G1) and 5 to 30 days (G2) (p: 0.09). The complete response occurred in 15 days with a range of 5–90 days for G1 and 30 days with a range of 5–90 days for G2 (p = 0.04).

Conclusion Within the limits of our study, we are able to show the interest of high dose of prednisolone during 4 days in the treatment of acute ITP.