Intravenous Anti-D Treatment of Immune Thrombocytopenic Purpura: Experience in 272 Patients

Abstract

We report the results of intravenous anti-D (WinRho, WinRho SD) therapy in 261 non-splenectomized patients treated at the New York Hospital-Cornell Medical Center over the period from 1987 to 1994. Children (n = 124) and adult patients (n = 137) with classic immune thrombocytopenic purpura (ITP; n = 156) or human immunodeficiency virus (HIV) related thrombocytopenia (n = 105) and acute (n = 75) or chronic (n = 186) disease at the time of the initial anti-D treatment were studied. In addition, 11 previously splenectomized patients were treated as a separate group. Our objectives were to evaluate the following. (1) Efficacy of anti-D: The response after the initial infusion was analyzed according to clinical parameters, such as patient's age, HIV status, gender, disease duration, pretreatment platelet count, and hemoglobin value, as well as treatment-related factors, including the dose of anti-D, the solvent detergent treatment of the preparation, and the type of administration. (2) Use of anti-D as maintenance therapy: The duration of response after the initial infusion and the results of subsequent treatments were evaluated. (3) Safety/toxicity of anti-D: Postinfusion reactions and hemoglobin decrease after treatment were studied. Anti-D is a safe treatment providing a hemostatic platelet increase in greater than 70% of the Rh+ non-splenectomized patients. The group with the best results is HIV− children, but all patient groups respond and the effect lasts more than 21 days in 50% of the responders. Duration of response is not influenced by HIV status; furthermore, HIV+ patients show no adverse effects on hemoglobin decrease or HIV disease progression. Patients with chronic ITP after splenectomy have minimal or no response to intravenous anti-D.

Intravenous (IV) anti‐D and IV immunoglobulin achieve acute platelet increases by different mechanisms: modulation of cytokine and platelet responses to IV anti‐D by FcγRIIa and FcγRIIIa polymorphisms

“…. In contrast, IV anti-D is more effective than IVIG in patients with human immunodeficiency virus (HIV)-related thrombocytopenia (Scaradavou et al, 1997) and may have longer-lasting effects on the platelet count (Newman et al, 2001). Furthermore, individual patients may respond better to one treatment than the other .…”

Retrospective evaluation of long-term efficacy and safety of splenectomy in chronic idiopathic thrombocytopenic purpura in children

“…Splenectomy-sparing strategies for paediatric cITP include corticosteroids (8,9), intravenous g-globulin (IVIG) (2,5,10) and anti-D (11,12). All three approaches are not always effective and certainly not "curative" (12).…”

Rozrolimupab, a mixture of recombinant human monoclonal anti‐D antibodies, for the treatment of primary immune thrombocytopenia – a review

“…A fall in haemoglobin to less than 100 g/l was observed in 24% of the cases treated with anti-D immunoglobulin. The largest group of 272 ITP patients treated with anti-D immunoglobulin was reported by Scaradavou et al [15]. In this study, platelet increases in children were twofold higher than those in adults (P < .001).…”