In a randomized trial, high-dose dexamethasone (40 mg daily x 4 days) was shown to lead to a faster response compared to prednisone, and without additional toxicity. However there was no difference in platelet count response at 6 months. Consider dexamethasone if quick response is particularly important, for example in a patient who is bleeding or needs to have surgery.
The following data are from the randomized trial mentioned above. The captions speak for themselves:
Guideline recommendations: