• Higher dose pulsed steroids associated with improved outcomes and minimal side effects
  • Usually used in combination with PLEX:
    • Intravenous daily methylprednisolone (1 g/day for three consecutive days)
    • Oral prednisolone (e.g. 1 mg/kg/day)
  • Shown to be effective and safe in refractory immune mediated TTP
  • Now recommended for all patients with:
    • Cardiac or neurological pathology on admission in conjunction with steroids and PLEX:
    • Refractory or relapsing immune-mediated TTP
  • Usually given in a dose of 375 mg/m2 has been used weekly for 4 weeks
  • PLEX should be withheld for at least 4 h after completing a rituximab infusion