Phase II Trial of Methylprednisolone Pulse Therapy in Childhood Chronic Thrombocytopenia

Abstract

Nineteen children with chronic idiopathie thrombocytopenia (ITP) were treated with a single intravenous injection of methylprednisolone (MP), 15 mg/kg/day, for 3 consecutive days. The 3-day pulses gave rise to a positive and fast therapeutic response with increase of the platelet count in about three quarters of the patients. The platelet count remained above 50 × 10⁹/1 for more than 1 month in 10 children. Eight out of them still presented a safe platelet count ( > 50 × 10⁹/1) 4 months after the onset of the therapy. The MP therapy improved the platelet count more in the older children and possibly in the females. No severe side effects were observed. Our results suggest that this therapeutic approach could be useful in the management of acute bleeding episodes in children with chronic ITP.

High Dose Intravenous Methylprednisolone for Chronic Idiopathic Thrombocytopenic Purpura

“…Forty-nine children with acute ITP were divided into three groups consisting of 17, 16 and 16 children, respec- (table 2). Although, in our protocol, intravenous methylprednisolone was used for longer periods and in higher doses than by Del Principe et al [8], all the above findings are evidence for the efficacy of HIVMP treatment in childhood ITP. I would like to add that with the exception of Cushingoid appear ance, side effects of corticosteroid treatment, such as hypertension, hyperglycemia, glucosuria, corneal opacities, have not been observed.…”

High‐dose intravenous methylprednisolone for acute childhood idiopathic thrombocytopenic purpura

“…Our results with oral prednisone coincide with Lusher & Iyer's (9) conclusion, based on a retrospective analysis of 236 children with ITP, although this is contrary to several more recent studies (10)(11)(12). Platelet response in 3 d was observed only in the HIVMP groupas it was in chronic ITP (6,13). This early platelet response was also observed in most of the 6 patients unresponsive to oral prednisone who were treated 4 months later with HIVMP (Table 2).…”

Methylprednisolone in Childhood Idiopathic Thrombocytopenic Purpura

“…The authors do not specify, in fact, if the nonresponders had been splenectomized. As a matter of fact, we treated unsplenectomized children [1], so that our patients were not comparable with those reported by Lam and Yuen. Moreover, it is unknown if the patient who de veloped a severe thrombocytopenia had been treated before with long-term steroid therapy and when it was stopped.…”

“…The report on methylprednisolone (MP) pulse therapy in childhood chronic idiopathic thrombocyto penic purpura (ITP) by del Principe et al [1] indicated it to be safe and promising. Our result in 3 children with chronic ITP treated with this drug, however, was discouraging.…”