Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin

Tarantino, Michael D.; Madden, Renée M.; Fennewald, D.Lucille; Patel, Chandrakant C.; Bertolone, Salvatore

doi:10.1016/s0022-3476(99)70367-7

Cited by 64 publications

(30 citation statements)

References 29 publications

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“…Both intravenous gammaglobulin (IVIG) and anti-D treatment have been proven effective in increasing the platelet counts in patients with HIV-TP [11][12][13][14][15]. How-ever, only retrospective studies comparing these two treatments have been reported in this clinical setting [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison

Scaradavou

Cunningham‐Rundles

et al. 2006

American J Hematol

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This small, prospective, randomized study compared increases in platelet counts and duration of response after intravenous gammaglobulin (IVIG) and IV anti-D in patients with HIVrelated thrombocytopenia (HIV-TP). Nine Rh+, nonsplenectomized HIV-positive patients with thrombocytopenia were treated sequentially, in random order, with IVIG and IV anti-D in a cross over design, receiving each therapy for 3 months. Peak platelet counts and duration of effect after each treatment were compared. In addition, viral load measurements and CD4 counts were followed serially, as well as thrombopoietin levels. IV anti-D resulted in a mean peak platelet count of 77 x 10 9 /L compared to only 29 x 10 9 /L after IVIG (P = 0.07). The mean duration of response was significantly longer in patients treated with anti-D (41 days) compared to IVIG (19 days, P ¼ 0.01). No consistent changes were seen in the CD4 counts or viral load measurements as a result of either therapy. Thrombopoietin levels were normal in all patients despite often severe thrombocytopenia. Anti-D was more efficacious than IVIG for the treatment of HIV-TP, confirming and extending previous results. Anti-D should be the first line therapy in HIV-positive, Rh+ patients, when antiretroviral agents are not indicated, not effective, or there is an urgent need to increase the platelet count. Am. J. Hematol. 82:335-341, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Introductionmentioning

confidence: 99%

Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison

Scaradavou

Cunningham‐Rundles

et al. 2006

American J Hematol

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“…Unfortunately there is no large randomized study in children that compares each of these modalities with observation alone. Several smaller randomized and retrospective studies have indicated that all three modalities can increase the platelet counts [10][11][12][13][14]. Most studies indicate that IVIG increases the platelet count the fastest [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

et al. 2005

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Data were reviewed on treatment patterns, outcome, and hospital charges for children with idiopathic thrombocytopenic purpura (ITP). Records of 186 children with ITP, seen between January 1997 and April 2001, were reviewed. Hospital charges for initial management and first re-treatment were calculated by combining physician, hospital, and pathology charges. Anti-D immune globulin [anti-D IG] was used in 32.3%, intravenous immune globulin [IVIG] in 22.6%, steroids in 22.6%, combination therapies in 8%, and 14.5% were observed. Two patients had CNS bleeding, one with intraventricular hemorrhage at diagnosis, and the other with a parietal bleed 1 year from diagnosis. There was no significant differences in time to reach platelet counts of 20, 50, or 150 (·10 9 /L) across different treatment groups. There was no significant difference in median charges for the IVIG and anti-D IG groups for the initial treatment of ITP. However, the IVIG was significantly more expensive than steroids or observation. Charges for the anti-D IG group were higher than the observation group but not the steroid group. After drug charges were excluded, patients in the IVIG group had statistically higher charges compared to patients in anti-D IG group. Almost half the patients were re-treated. There was no significant difference between anti-D IG, IVIG, and steroid groups when initial and re-treatment charges were combined. The observation group remained least expensive. Outcome for children with ITP is similar regardless of initial management. There is not a statistically significant difference in hospital charges between patients treated with anti-D IG and IVIG. The IVIG-treated group tends to be more costly, but this is not due to drug charges. Re-treatment is common and decreases the difference in patient charges among initial therapies. Am.

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“…However, no difference was observed between the 2 groups in this regard. Different studies have reported decreased hemoglobin levels after IVIG and anti-D administration (4,18,19,32). The decrease may also be dose-related; the decrease has been reported to be 1.6, 2, and 0.3 g/dL in those receiving 50 µg/kg and 75 µg/kg of anti-D, and IVIG, respectively (30).…”

Section: Discussionmentioning

confidence: 99%

“…This disorder has different clinical signs, including petechiae, mucosal bleeding, and ecchymosis (3), yet the most important finding of this disease is intracranial hemorrhage (4,5). Although intracranial hemorrhage (ICH) is rare, it may result in serious complications, especially in children, and therefore its prevention is the primary objective of ITP treatment (2).…”

Section: Introductionmentioning

confidence: 99%

“…Although anti-D has minor adverse effects, such as headache, vomiting, fever, and chills (16), it is cheaper and more tolerable and has a more stable effectiveness in comparison with IVIG (17). Moreover, it has a very short time of infusion and single dose administration reduces the risk of infection in users (4). A number of studies have shown the greater potency of this drug versus IVIG in increasing platelet count in cases like ITP secondary to HIV infection (18,19).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of the Therapeutic Effect of Anti-D IG and IVIG in Children with Acute Immune Thrombocytopenic Purpura Attending a Children’s Medical Center: A Randomized, Double-Blind, Controlled Clinical Trial

et al. 2017

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Background: This study aimed at comparing the therapeutic effect of anti-D immunoglobulin (anti-D IG) and Intravenous Immunoglobulin (IVIG) in children with acute immune thrombocytopenic purpura (ITP). Methods: This Randomized double-blind, controlled clinical trial was conducted on 98 children attending a Children's medical center during year 2008. The selected participants were allocated to IVIG and anti-D IG groups using the balanced-block randomization method. The platelet count, hemoglobin level, and side effects of the medications were evaluated on days 1, 3, 7, 14, and 21 after drug injection. Results: After drug injection, the platelet count increased in both groups (P < 0.001) yet there was no difference between the 2 groups (P > 0.05). The hemoglobin level also decreased after injection in both groups (P < 0.001) and the decrease was similar in both groups (P > 0.05). Regarding the ability of the drugs to increase the platelet count, 56% of the patients in the anti-D IG group and 52% of the children in the IVIG groups had platelet counts of more than 20 000 during the 24 hours after drug administration with no difference between the 2 groups (P = 0.836). The incidence of drug adverse effects, including fever and chills (4.1% in the anti-D group versus 10.4% in the IVIG group), severe hemolysis (4.5% in the anti D group versus 0% in the IVIG group) and headache (6.25% in the anti-D group versus 4.1% in the IVIG group), had no significant difference between the two groups (P > 0.05). Conclusions: Intravenous Immunoglobulin and anti-D have similar effectiveness in the treatment of children with acute ITP. Considering the fewer side effects of anti-D, it may be a suitable replacement for IVIG in ITP patients.

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Treatment of childhood acute immune thrombocytopenic purpura with anti-D immune globulin or pooled immune globulin

Cited by 64 publications

References 29 publications

Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison

Superior effect of intravenous anti‐D compared with IV gammaglobulin in the treatment of HIV‐thrombocytopenia: Results of a small, randomized prospective comparison

Treatment, outcome, and cost of care in children with idiopathic thrombocytopenic purpura

Comparison of the Therapeutic Effect of Anti-D IG and IVIG in Children with Acute Immune Thrombocytopenic Purpura Attending a Children’s Medical Center: A Randomized, Double-Blind, Controlled Clinical Trial

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