Login Register Cart 0
Generic placeholder image

Current Pediatric Reviews

Editor-in-Chief

ISSN (Print): 1573-3963
ISSN (Online): 1875-6336

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Systematic Review Article

First Line Treatments for Newly Diagnosed Primary Immune Thrombocytopenia in Children: A Systematic Review and Network Meta-analysis

Author(s): David O. Acero-Garcés and Herney A. García-Perdomo *

Volume 16, Issue 1, 2020

Page: [61 - 70] Pages: 10

DOI: 10.2174/1573396315666191023122542

Abstract

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.

Keywords: Purpura, thrombocytopenic, idiopathic, immunoglobulins, intravenous, Rho(D) Immune globulin, glucocorticoids, child health.

« Previous Next »
Graphical Abstract

[1]
Frederiksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. Blood 1999; 94(3): 909-13.
[PMID: 10419881]
[2]
Neylon AJ, Saunders PWG, Howard MR, Proctor SJ, Taylor PRA. Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients. Br J Haematol 2003; 122(6): 966-74.
[http://dx.doi.org/10.1046/j.1365-2141.2003.04547.x] [PMID: 12956768]
[3]
Terrell DR, Beebe LA, Neas BR, Vesely SK, Segal JB, George JN. Prevalence of primary immune thrombocytopenia in Oklahoma. Am J Hematol 2012; 87(9): 848-52.
[http://dx.doi.org/10.1002/ajh.23262] [PMID: 22674643]
[4]
Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost 2006; 4(11): 2377-83.
[http://dx.doi.org/10.1111/j.1538-7836.2006.02147.x] [PMID: 16869934]
[5]
Yong M, Schoonen WM, Li L, et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. Br J Haematol 2010; 149(6): 855-64.
[http://dx.doi.org/10.1111/j.1365-2141.2010.08176.x] [PMID: 20377590]
[6]
Kistangari G, McCrae KR. Immune thrombocytopenia. Hematol Oncol Clin North Am 2013; 27(3): 495-520.
[http://dx.doi.org/10.1016/j.hoc.2013.03.001] [PMID: 23714309]
[7]
Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115(2): 168-86.
[http://dx.doi.org/10.1182/blood-2009-06-225565] [PMID: 19846889]
[8]
Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113(11): 2386-93.
[http://dx.doi.org/10.1182/blood-2008-07-162503] [PMID: 19005182]
[9]
Albayrak D, Işlek I, Kalaycí AG, Gürses N. Acute immune thrombocytopenic purpura: a comparative study of very high oral doses of methylprednisolone and intravenously administered immune globulin. J Pediatr 1994; 125(6 Pt 1): 1004-7.
[http://dx.doi.org/10.1016/S0022-3476(05)82024-4] [PMID: 7996346]
[10]
Alioglu B, Ercan S, Tapci AE, Zengin T, Yazarli E, Dallar Y. A comparison of intravenous immunoglobulin (2 g/kg totally) and single doses of anti-D immunoglobulin at 50 μg/kg, 75 μg/kg in newly diagnosed children with idiopathic thrombocytopenic purpura: Ankara hospital experience. Blood Coagul Fibrinolysis 2013; 24(5): 505-9.
[http://dx.doi.org/10.1097/MBC.0b013e32835e5337] [PMID: 23470649]
[11]
Ancona KG, Parker RI, Atlas MP, Prakash D. Randomized trial of high-dose methylprednisolone versus intravenous immunoglobulin for the treatment of acute idiopathic thrombocytopenic purpura in children. J Pediatr Hematol Oncol 2002; 24(7): 540-4.
[http://dx.doi.org/10.1097/00043426-200210000-00008] [PMID: 12368690]
[12]
Blanchette VS, Luke B, Andrew M, et al. 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 Pediatr 1993; 123(6): 989-95.
[http://dx.doi.org/10.1016/S0022-3476(05)80400-7] [PMID: 8229536]
[13]
Duru F, Fisgin T, Yarali N, Kara A. Clinical course of children with immune thrombocytopenic purpura treated with intravenous immunoglobulin G or megadose methylprednisolone or observed without therapy. Pediatr Hematol Oncol 2002; 19(4): 219-25.
[http://dx.doi.org/10.1080/08880010252899370] [PMID: 12051587]
[14]
Erduran E, Aslan Y, Gedik Y, Orhan F. A randomized and comparative study of intravenous immunoglobulin and mega dose methylprednisolone treatments in children with acute idiopathic thrombocytopenic purpura. Turk J Pediatr 2003; 45(4): 295-300.
[PMID: 14768792]
[15]
Ozsoylu S, Irken G, Karabent A. High-dose intravenous methylprednisolone for acute childhood idiopathic thrombocytopenic purpura. Eur J Haematol 1989; 42(5): 431-5.
[http://dx.doi.org/10.1111/j.1600-0609.1989.tb01466.x] [PMID: 2731592]
[16]
Ozsoylu S, Sayli TR, Oztürk G. Oral megadose methylprednisolone versus intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol 1993; 10(4): 317-21.
[http://dx.doi.org/10.3109/08880019309029508] [PMID: 8292515]
[17]
Papagianni A, Economou M, Tragiannidis A, et al. Standard-dose intravenous anti-D immunoglobulin versus intravenous immunoglobulin in the treatment of newly diagnosed childhood primary immune thrombocytopenia. J Pediatr Hematol Oncol 2011; 33(4): 265-9.
[http://dx.doi.org/10.1097/MPH.0b013e31820e2aa5] [PMID: 21516022]
[18]
Shahgholi E, Vosough P, Sotoudeh K, et al. Intravenous immune globulin versus intravenous anti-D immune globulin for the treatment of acute immune thrombocytopenic purpura. Indian J Pediatr 2008; 75(12): 1231-5.
[http://dx.doi.org/10.1007/s12098-008-0243-y] [PMID: 19190878]
[19]
Son DW, Jeon IS, Yang SW, Cho SH. A single dose of anti-D immunoglobulin raises platelet count as efficiently as intravenous immunoglobulin in newly diagnosed immune thrombocytopenic purpura in Korean children. J Pediatr Hematol Oncol 2008; 30(8): 598-601.
[http://dx.doi.org/10.1097/MPH.0b013e31817541ba] [PMID: 18799936]
[20]
Tarantino MD, Young G, Bertolone SJ, et al. Single dose of anti-D immune globulin at 75 microg/kg is as effective as intravenous immune globulin at rapidly raising the platelet count in newly diagnosed immune thrombocytopenic purpura in children. J Pediatr 2006; 148(4): 489-94.
[http://dx.doi.org/10.1016/j.jpeds.2005.11.019] [PMID: 16647411]
[21]
Blanchette V, Imbach P, Andrew M, et al. Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet 1994; 344(8924): 703-7.
[http://dx.doi.org/10.1016/S0140-6736(94)92205-5] [PMID: 7915773]
[22]
Lioger B, Maillot F, Ternant D, Passot C, Paintaud G, Bejan-Angoulvant T. Efficacy and safety of anti-D immunoglobulins versus intravenous immunoglobulins for immune thrombocytopenia in children: Systematic review and meta-analysis of randomized controlled trials. J Pediatr 2019; 204: 225-233.e8.
[http://dx.doi.org/10.1016/j.jpeds.2018.07.065] [PMID: 30314658]
[23]
Qin W, Huang S-L, Li T-T. [Clinical effect of anti-D immunoglobulin in treatment of childhood immune thrombocytopenia: a Meta analysis]. Zhongguo Dang Dai Er Ke Za Zhi 2017; 19(10): 1070-6.
[PMID: 29046203]
[24]
Qin Y-H, Zhou T-B, Su L-N, Lei F-Y, Zhao Y-J, Huang W-F. The efficacy of different dose intravenous immunoglobulin in treating acute idiopathic thrombocytopenic purpura: a meta-analysis of 13 randomized controlled trials. Blood Coagul Fibrinolysis 2010; 21(8): 713-21.
[http://dx.doi.org/10.1097/MBC.0b013e3283401490] [PMID: 20962624]
[25]
Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. 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. J Pediatr 2005; 147(4): 521-7.
[http://dx.doi.org/10.1016/j.jpeds.2005.04.032] [PMID: 16227040]
[26]
Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117(16): 4190-207.
[http://dx.doi.org/10.1182/blood-2010-08-302984] [PMID: 21325604]
[27]
Heitink-Pollé KMJ, Nijsten J, Boonacker CWB, de Haas M, Bruin MCA. Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis. Blood 2014; 124(22): 3295-307.
[http://dx.doi.org/10.1182/blood-2014-04-570127] [PMID: 25305206]
[28]
Bolton-Maggs PHB, Dickerhoff R, Vora AJ. The nontreatment of childhood ITP (or “the art of medicine consists of amusing the patient until nature cures the disease”). Semin Thromb Hemost 2001; 27(3): 269-75.
[http://dx.doi.org/10.1055/s-2001-15256] [PMID: 11446660]
[29]
Dickerhoff R, von Ruecker A. The clinical course of immune thrombocytopenic purpura in children who did not receive intravenous immunoglobulins or sustained prednisone treatment. J Pediatr 2000; 137(5): 629-32.
[http://dx.doi.org/10.1067/mpd.2000.110123] [PMID: 11060527]
[30]
Altomare I, Wasser J, Pullarkat V. Bleeding and mortality outcomes in ITP clinical trials: a review of thrombopoietin mimetics data. Am J Hematol 2012; 87(10): 984-7.
[http://dx.doi.org/10.1002/ajh.23275] [PMID: 22729832]
[31]
Celik M, Bulbul A, Aydogan G, et al. Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura. J Thromb Thrombolysis 2013; 35(2): 228-33.
[http://dx.doi.org/10.1007/s11239-012-0801-z] [PMID: 22956408]

Rights & Permissions Print Cite
Article Metrics
56
5
World Autism Awareness Day
© 2024 Bentham Science Publishers | Privacy Policy