Background: The first-line interventions in immune thrombocytopenia (ITP) include intravenous polyclonal immunoglobulins (IVIg), corticosteroids and anti-D immunoglobulin (anti-D).
Objective: We aimed to compare the effectiveness and safety of first line treatments for newlydiagnosed primary ITP in children to increase the platelet count.
Methods: We searched MEDLINE, EMBASE, LILACS and the Cochrane Central register of Controlled Trials (CENTRAL); and included the clinical trials. We performed the statistical analysis in R.
Results: We included 12 studies for meta-analysis. Compared with IVIG 2g/kg, response rates were lower for prednisone 2mg/kg at 72 hours [RR 0.04 (95% CI 0.0 to 0.68)] and at 7 days [RR 0.23 (95% CI 0.08 to 0.67)]; at 48 hours, methylprednisolone 30mg/kg also showed lower response rates [RR 0.72 (95% CI 0.52 to 0.99)]. IVIG 2g/kg and 2.5g/kg had less adverse effects than Anti- D, methylprednisolone and IVIG 0.8g/kg. For rising platelet count, no statistical differences were found at 24 hours or in 7 days; at 48 hours, IVIG 2g/kg showed better results than Anti-D 75μg/kg [MD -58.84 (95% CI -87.02 to -25.66)]. After a month, platelet count with IVIG 2g/kg was higher than Anti-D 50 and 75μg/kg [-82.03 (95% CI -102.60 to -61.46) and -78.77 (95% CI -97.80 to - 59.74), respectively], but lower than methylprednisolone 50mg/kg [MD 118 (95% CI 3.88 to 232.12)].
Conclusion: The total platelet count rises higher in early and late phases with IVIG than Anti-D, but in long term it is higher with methylprednisolone. Additionally, IVIG causes less adverse effects than Anti-D and corticosteroids.
[http://dx.doi.org/10.1046/j.1365-2141.2003.04547.x] [PMID: 12956768]
[http://dx.doi.org/10.1111/j.1538-7836.2006.02147.x] [PMID: 16869934]
[http://dx.doi.org/10.1111/j.1365-2141.2010.08176.x] [PMID: 20377590]
[http://dx.doi.org/10.1182/blood-2008-07-162503] [PMID: 19005182]
[http://dx.doi.org/10.1097/MBC.0b013e32835e5337] [PMID: 23470649]
[http://dx.doi.org/10.1097/00043426-200210000-00008] [PMID: 12368690]
[http://dx.doi.org/10.1016/S0022-3476(05)80400-7] [PMID: 8229536]
[http://dx.doi.org/10.1080/08880010252899370] [PMID: 12051587]
[http://dx.doi.org/10.1111/j.1600-0609.1989.tb01466.x] [PMID: 2731592]
[http://dx.doi.org/10.1097/MPH.0b013e31820e2aa5] [PMID: 21516022]
[http://dx.doi.org/10.1097/MPH.0b013e31817541ba] [PMID: 18799936]
[http://dx.doi.org/10.1016/j.jpeds.2005.11.019] [PMID: 16647411]
[http://dx.doi.org/10.1016/j.jpeds.2018.07.065] [PMID: 30314658]
[http://dx.doi.org/10.1097/MBC.0b013e3283401490] [PMID: 20962624]
[http://dx.doi.org/10.1016/j.jpeds.2005.04.032] [PMID: 16227040]