Oral Megadose Methylprednisolone Versus Intravenous Immunoglobulin for Acute Childhood Idiopathic Thrombocytopenic Purpura

Özsoylu, Şînasi; Şaylı, Tülin Revide; Öztürk, Gülyüz

doi:10.3109/08880019309029508

Cited by 53 publications

(34 citation statements)

References 12 publications

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“…In our analysis, children with ITP initially treated with IVIG were more likely to have platelet counts ‡150 · 10 9 /l and ‡50 · 10 9 /l at 6 months from diagnosis than children initially receiving no or other drug treatment. Among studies involving randomization between corticosteroids and IVIG and with a follow-up of at least 6 months, none have demonstrated a significant long-term effect in favour of IVIG treatment (Imbach et al, 1985;Blanchette et al, 1993Blanchette et al, , 1994Ozsoylu et al, 1993;Albayrak et al, 1994;Fujisawa et al, 2000;Ancona et al, 2002;Duru et al, 2002;Erduran et al, 2003). However, a recent meta-analysis of these nine studies (Imbach et al, 1985;Blanchette et al, 1993Blanchette et al, , 1994Ozsoylu et al, 1993;Albayrak et al, 1994;Fujisawa et al, 2000;Ancona et al, 2002;Duru et al, 2002;Erduran et al, 2003) found a statistically significant beneficial effect of IVIG 6 months after diagnosis (Beck et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

Tamminga

Berchtold²,

Bruin

et al. 2009

Br J Haematol

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SummaryIn children, one‐third of immune thrombocytopenic purpura (ITP) patients follow a chronic course. The present study investigated whether treatment with intravenous immunoglobulin (IVIG) at the time of diagnosis of ITP is of prognostic significance, using data from 1984 children entered in Registry I of the Intercontinental Cooperative ITP Study Group. A matched pairs analysis compared children with thrombocytopenia (platelet count <150 × 109/l) 6 months following diagnosis with children whose platelet count was normal 6 months after diagnosis. It was found that children initially treated with IVIG were more likely to have a normal platelet count 6 months after diagnosis than children not receiving IVIG (odds ratio 1·81; 95% confidence interval: 1·25–2·64). This result was independent of age, gender, country of origin, platelet count at diagnosis or infection preceding the diagnosis of ITP. In a similar analysis, comparing children with a platelet count <50 × 109/l 6 months after diagnosis with children whose platelet count was ≥50 × 109/l at that time point, the former group was less often treated with IVIG than with steroids (P = 0·02). Prospective studies are required to further explore this potential effect of IVIG.

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Section: Discussionmentioning

confidence: 99%

Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

Tamminga

Berchtold²,

Bruin

et al. 2009

Br J Haematol

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“…198 High-dose methylprednisolone. HDMP (given as an oral 7-day course of 30 mg/kg/d for 3 days followed by 20 mg/kg/d for 4 days) has been used as an alternative to IVIg [200][201][202] (evidence level Ib-III).…”

Section: Treatment Options For Children With Persistent or Chronic Itpmentioning

confidence: 99%

International consensus report on the investigation and management of primary immune thrombocytopenia

Provan¹,

Stasi

Newland³

et al. 2010

Blood

1,835

1,954

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IntroductionPrimary immune thrombocytopenia (ITP) is an acquired immunemediated disorder characterized by isolated thrombocytopenia, defined as a peripheral blood platelet count less than 100 ϫ 10 9 /L, and the absence of any obvious initiating and/or underlying cause of the thrombocytopenia. 1 Until recently, the abbreviation ITP stood for idiopathic thrombocytopenic purpura, but current awareness relating to the immune-mediated nature of the disease, and the absence or minimal signs of bleeding in a large proportion of cases have led to a revision of the terminology. 1 Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of increased platelet destruction mediated by autoantibodies to more complex mechanisms in which both impaired platelet production and T cell-mediated effects play a role. [2][3][4][5][6] Recent epidemiologic data suggest that the incidence in adults is approximately equal for the sexes except in the mid-adult years (30-60 years), when the disease is more prevalent in women. 7,8 ITP is classified by duration into newly diagnosed, persistent (3-12 months' duration) and chronic (Ն 12 months' duration). 1 Whereas ITP in adults typically has an insidious onset with no preceding viral or other illness and it normally follows a chronic course, 9 ITP in children is usually short-lived with at least two-thirds recovering spontaneously within 6 months. 10 Signs and symptoms vary widely. Many patients have either no symptoms or minimal bruising, whereas others experience serious bleeding, which may include gastrointestinal hemorrhage (GI), extensive skin and mucosal hemorrhage, or intracranial hemorrhage (ICH). The severity of thrombocytopenia correlates to some extent but not completely with the bleeding risk. 7,11 Additional factors (eg, age, lifestyle factors, uremia) affect the risk and should be evaluated before the appropriate management is determined.The investigation and management of ITP patients vary widely. The purpose of this consensus document is to comment on new data and provide recommendations relating to diagnosis and treatment. Final judgment regarding care of individual patients should, however, lie with the responsible health care professional and be based on careful investigation of individual circumstances. MethodsComposition of the panel. The panel included 22 members with recognized clinical and research expertise in ITP representing North America (United States, 7; Canada, 1), Europe (France, 1; Italy, 2; Spain, 1; Switzerland, 1; United Kingdom, 8), and Australia (1).Assessment of the literature. Articles were identified by a computer-assisted search of the literature published in English using the National Library of Medicine PubMed database. The For personal use only. on May 7, 2018. by guest www.bloodjournal.org From search criteria were: 'immune thrombocytopenic purpura', 'idiopathic thrombocytopenic purpura', 'ITP', and 'autoimmune thrombocytopenic purpura'. A subsequent search was performed using the corresponding MedLin...

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“…In acute ITP , treatment options include corticosteroids, IVIG and anti-D IgG and thrombocyte suspension in conditions where bleeding can not be stopped or in case of urgent surgical intervention (1,23,38,(39)(40)(41)(42)(43)(44). In recent years, interferon, monoclonal antibodies (rituksimab) and helycobacter treatment have also been tried (38).…”

Section: Treatment Of Acute Childhood Itpmentioning

confidence: 99%

2011 yılında çocukluk çağı immün trombositopenik purpura hastalığı izlem ve tedavisinde değişiklikler

Çelkan¹

2012

tpa

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Immune thrombocytopenic purpura (ITP) is the most frequent hemorrhagic disease in children. The shortened life of platelets because of immunologic damage (antibodies absorbed by platelets) and insufficient compensatory increased function of the bone marrow result in reduced number of platelets in the peripheral blood. There are three forms of ITP: acute, chronic and persistent. The acute form occurs in 80-90% of cases with bleeding episodes lasting a few days or weeks, but no longer than 6 months. The new 2011 ASH guideline increased this period to one year. It is typical for the phenomenon of bleeding that it starts suddenly and without any other sign of illness. The most frequent acute form appears between the second and fourth year and it usually occurs after acute viral infections. Children older than 10 years of age, like adults, often have the chronic form associated with other immunologic disorders. Hemorrhagic manifestations include: petechiae, purpura, epistaxis, gastrointestinal and genitourinary bleeding. They depend on the grade of thrombocytopenia, although there is no strict correlation between the number of platelets and volume of bleeding. In cases of acute ITP in children, usually there are two therapeutic options or therapies of choice: corticosteroids and high doses of intravenous immunoglobulin. There are also immunosupressive therapy, anti Rh(D) immunoglobulin, cyclosporine, cytostatics, danazol, rituximab, and TPO receptor agonists. In cases of distinctive hemorrhagic syndrome, there are also indications for platelet transfusion. Nowadays splenectomy is more restricted, because one third of cases are unsuccessful. (Turk Arch Ped 2012; 47: 8-17)

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Oral Megadose Methylprednisolone Versus Intravenous Immunoglobulin for Acute Childhood Idiopathic Thrombocytopenic Purpura

Cited by 53 publications

References 12 publications

Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)

International consensus report on the investigation and management of primary immune thrombocytopenia

2011 yılında çocukluk çağı immün trombositopenik purpura hastalığı izlem ve tedavisinde değişiklikler

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