Randomized trial of high-dose methylprednisolone versus intravenous immunoglobulin for the treatment of acute idiopathic thrombocytopenic purpura in children

被引:31
作者
Ancona, KG [1 ]
Parker, RI [1 ]
Atlas, MP [1 ]
Prakash, D [1 ]
机构
[1] SUNY Stony Brook, Dept Pediat, Stony Brook, NY 11794 USA
关键词
high-dose methylprednisolone; idiopathic thrombocytopenic purpura; intravenous immunoglobulin;
D O I
10.1097/00043426-200210000-00008
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Idiopathic thrombocytopenic purpura (ITP) is an acquired disorder characterized by immune-mediated platelet destruction. The authors performed a prospective, randomized trial comparing intravenous immunoglobulin (IVIG) with high-dose intravenous methylprednisolone in the treatment of children with acute ITP. The primary aim of the study was to compare the rate of platelet increase produced by either intervention. A decision to treat was based on the clinical presentation and not an arbitrary platelet count. In general, enrolled patients exhibited extensive bruising and platelet counts less than 10 x 10(9)/L (10,000/muL). Patients and Methods: Seventy-seven consecutive patients, for whom the attending hematologist determined acute treatment was warranted, were studied. Forty-two patients received IVIG (1 g/kg/dose x2) and 35 received methylprednisolone (30 mg/kg/dose x3). Patients who exhibited an increase in platelet count of more than 50,000/muL after the first IVIG dose or the second methylprednisolone dose did not receive the second IVIG dose or the third methylprednisolone dose, respectively. Patients' ages ranged from 6 months to 15 years. Platelet counts were evaluated at presentation, 24, 48, 72 hours, I week, and 2 to 4 weeks. Results: Eighty percent of patients treated with IVIG and 60% of patients treated with methylprednisolone demonstrated an increase in platelet count of 50,000/muL or more within 48 hours. Both IVIG and methylprednisolone therapy increased platelet counts significantly above pretreatment values. In the methylprednisolone group, the mean baseline platelet count was 4,600/muL, which rose to 14,000/muL after 24 hours, 38,000/muL after 48 hours, and 65,000/muL after 72 hours. The IVIG group had a mean baseline platelet count of 4,200/muL, which rose to 32,000/muL after 24 hours, 69,000/muL after 48 hours, and 146,000/muL after 72 hours. When compared with methylprednisolone, IVIG therapy produced a greater rise in platelet counts at 24, 48, and 72 hours, with no difference at I week or later time points. No serious bleeding was noted in either treatment group. Conclusions: Both IVIG and methylprednisolone produce a significant early rise in platelet count that is somewhat greater with IVIG. However, the higher platelet counts produced by IVIG may not justify the additional cost and potential risks of this agent.
引用
收藏
页码:540 / 544
页数:5
相关论文
共 21 条
[1]   ACUTE IMMUNE THROMBOCYTOPENIC PURPURA - A COMPARATIVE-STUDY OF VERY HIGH ORAL DOSES OF METHYLPREDNISOLONE AND INTRAVENOUSLY ADMINISTERED IMMUNE GLOBULIN [J].
ALBAYRAK, D ;
ISLEK, I ;
KALAYCI, AG ;
GURSES, N .
JOURNAL OF PEDIATRICS, 1994, 125 (06) :1004-1007
[2]   A PROSPECTIVE, RANDOMIZED TRIAL OF HIGH-DOSE INTRAVENOUS IMMUNE GLOBULIN G THERAPY, ORAL PREDNISONE THERAPY, AND NO THERAPY IN CHILDHOOD ACUTE IMMUNE THROMBOCYTOPENIC PURPURA [J].
BLANCHETTE, VS ;
LUKE, B ;
ANDREW, M ;
SOMMERVILLENIELSEN, S ;
BARNARD, D ;
DEVEBER, B ;
GENT, M .
JOURNAL OF PEDIATRICS, 1993, 123 (06) :989-995
[3]   Assessment of UK practice for management of acute childhood idiopathic thrombocytopenic purpura against published guidelines [J].
BoltonMaggs, PHB ;
Moon, I .
LANCET, 1997, 350 (9078) :620-623
[4]  
BUSSEL JB, 1995, BLOOD DIS INFANCY CH, P878
[5]   The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts [J].
Cohen, YC ;
Djulbegovic, B ;
Shamai-Lubovitz, O ;
Mozes, B .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (11) :1630-1638
[6]   IDIOPATHIC AND SECONDARY THROMBOCYTOPENIC PURPURA - CLINICAL STUDY AND EVALUATION OF 381 CASES OVER A PERIOD OF 28 YEARS [J].
DOAN, CA ;
BOURONCLE, BA ;
WISEMAN, BK .
ANNALS OF INTERNAL MEDICINE, 1960, 53 (05) :861-876
[7]  
DUHEM C, 1994, CLIN EXP IMMUNOL, V97, P79
[8]  
Fujisawa K, 2000, INT J HEMATOL, V72, P376
[9]   Idiopathic thrombocytopenic purpura: A practice guideline developed by explicit methods for the American Society of Hematology [J].
George, JN ;
Woolf, SH ;
Raskob, GE ;
Wasser, JS ;
Aledort, LM ;
Ballem, PJ ;
Blanchette, VS ;
Bussel, JB ;
Cines, DB ;
Kelton, JG ;
Lichtin, AE ;
McMillan, R ;
Okerbloom, JA ;
Regan, DH ;
Warrier, I .
BLOOD, 1996, 88 (01) :3-40
[10]  
IMBACH P, 1985, LANCET, V2, P464