Abstract: Objective To compare the efficacy of glucocorticoid combined with low-dose rituximab in the treatment of primary and recurrent primary immune thrombocytopenia (ITP). Methods A total of 51 patients were included in the study, 17 males and 34 females, with a median age of 27 (18-69) years; 28 patients with initial ITP (initial treatment group), 23 patients with recurrent ITP (recurrence group) after routine glucocorticoid treatment, including 20 patients with glucocorticoid dependence and 3 patients with ineffective glucocorticoid. The treatment regimen was: large dose of dexamethasone 40 mg/d on days 1-4, prednisone 60 mg/d on days 5-7, prednisone 30 mg/d on days 8-14, prednisone 20 mg/d on day 15-21, prednisone 10 mg/d on days 22-28, low dose of rituximab 100 mg intravenous drip on days 7, 14, 21 and 28. The efficacy and safety of ITP patients in initial treatment group and recurrence group were observed and compared. Results On the fourth day of treatment, the platelet count of the two groups was higher than that before treatment, the difference was statistically significant (P<0.05), there was no statistically significant difference between the two groups (P>0.05). On the seventh day of treatment, the platelet count of the two groups continued to rise, without statistically significant difference between the two groups (P>0.05). On the fourteenth and 28th days of treatment, the platelet count of the two groups were in a relatively safe level, without statistically significant difference between the two groups (P>0.05). On the 28th day and the 6th month of treatment, the total effective rate in the initial treatment group was higher than that in the recurrence group, but the difference was not statistically significant (P>0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions Glucocorticoid combined with low-dose rituximab has similar efficacy in the treatment of primary and recurrent immune thrombocytopenia, and there is no serious adverse reactions.