Treatment of Acute Idiopathic Thrombocytopenic Purpura
Patricia A. Stoeck
Howard J. Weinstein
Corticosteroids Versus Intravenous Immune Globulin for the Treatment of Acute Immune Thrombocytopenic Purpura in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Beck CE, Nathan PC, Parkin PC, et al. J Pediatr. 2005;147(4):521–527
Background
Although it is typically a self-limited condition, treatments for childhood immune thrombocytopenic purpura (ITP) have been pursued given the 0.2% to 1% risk of severe bleeding such as intracranial hemorrhage (ICH) with platelet counts <20,000/mm3. Previous guidelines for ITP management in children were based on expert opinion and qualitative studies and included therapies such as IV immune globulin (IVIG), Rho(D) immune globulin corticosteroids, and supportive care alone. This study represents the first systematic review comparing IVIG to corticosteroids.
Objectives
To compare efficacy of IVIG versus corticosteroids in treatment of acute ITP.
Methods
Systematic review and meta-analysis of 10 randomized controlled trials from 1985 to 2003.
Patients
615 patients ages 3 months to 18 years at the initial presentation of primary acute ITP. Select exclusion criteria: studies involving children with other causes of thrombocytopenia and prior ITP treatment.
Intervention
Administration of IVIG (0.4 to 1 g/kg/d for 1 to 5 days) vs. corticosteroids (methylprednisolone IV 10 to 30 mg/kg/d over 2 to 7 days or prednisone PO 2 to 4 mg/kg/d over 21 days, including taper). Platelet count following treatment initiation was measured.
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