Clinical Course of Children With Immune Thrombocytopenic Purpura Treated With Intravenous Immunoglobulin G or Megadose Methylprednisolone or Observed Without Therapy

Abstract

The authors compared the prognosis in 50 children with acute immune thrombocytopenicpurpura (ITP) who received intravenous immunoglobulin G (IVIG), megadose methylprednisolone (MDMP), or no therapy. Twenty-six children were observed with no therapy, 12 children received IVIG, and 12 children received MDMP. The percentage of the patients whose platelet counts increased at a level of > 20 x 10(9)/L and > 50 x 10(9)/L at 3 days after starting therapy was significantly higher in both IVIG and MDMP groups than in the no therapy group (p < .01), but there was no significant difference at 10 and 30 days after initiation between the 3 groups (p > .05 in each comparison). This result suggested that therapy does not increase the rate of recovery but shortens the duration of thrombocytopenia in the first days. Management derision in ITP is made on clinical condition rather than on platelet count and no treatment options is to be preferred even in the face of mucosal bleeding. If the patient has extensive bleeding and the decision is to treat, both IVIG and MDMP are equally effective in providing a safe platelet level early on.

Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

“…Commonly used therapeutic modalities for this disorder include systemic corticosteroids, anti-D IgG, or both or IGIV. 57 This is one of the FDA-approved indications for IGIV, and the ability of IGIV to increase platelet counts in this setting is supported by numerous data. [59][60][61][62] The mechanism of action is believed to be mediated by immunomodulatory capacity exerted by Fc receptor blockade and potentially through ligation of inhibitory Fc receptors.…”

“…Pharmacologic treatment of children with immune thrombocytopenic purpura is an actively debated issue because the vast majority of children recover spontaneously. [56][57][58] Regardless, treatment is usually provided for those children at the greatest risk for complications relating to bleeding or those having chronic refractory disease. Commonly used therapeutic modalities for this disorder include systemic corticosteroids, anti-D IgG, or both or IGIV.…”

Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

“…In our analysis, children with ITP initially treated with IVIG were more likely to have platelet counts ‡150 · 10 9 /l and ‡50 · 10 9 /l at 6 months from diagnosis than children initially receiving no or other drug treatment. Among studies involving randomization between corticosteroids and IVIG and with a follow-up of at least 6 months, none have demonstrated a significant long-term effect in favour of IVIG treatment (Imbach et al, 1985;Blanchette et al, 1993Blanchette et al, , 1994Ozsoylu et al, 1993;Albayrak et al, 1994;Fujisawa et al, 2000;Ancona et al, 2002;Duru et al, 2002;Erduran et al, 2003). However, a recent meta-analysis of these nine studies (Imbach et al, 1985;Blanchette et al, 1993Blanchette et al, , 1994Ozsoylu et al, 1993;Albayrak et al, 1994;Fujisawa et al, 2000;Ancona et al, 2002;Duru et al, 2002;Erduran et al, 2003) found a statistically significant beneficial effect of IVIG 6 months after diagnosis (Beck et al, 2005).…”

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

“…Lastly, Duru et al enrolled 26 children with a platelet count Ͻ 20 ϫ 10 9 /L and consented them to observation without drug treatment. 21 Ten (38%) had mucosal bleeding at presentation. Only 2 of the 26, both with epistaxis at diagnosis, required further intervention during the follow-up period, which ranged from 5-32 months.…”