Submit Manuscript  

Article Details


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

Author(s):

David Orlando Acero-Garcés and Herney Andrés García-Perdomo *   Pages 1 - 10 ( 10 )

Abstract:


Background: The first-line interventions in immune thrombocytopenia (ITP) consist in 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 newly-diagnosed primary ITP in children to increase the platelet count.

Methods: We searched MEDLINE, EMBASE, LILACS, and the Cochrane Central register of Controlled Trials (CENTRAL); we included 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 at 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)]. At one 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:

Idiopathic Thrombocytopenic Purpura, Intravenous Immunoglobulins, Rho(D) Immune Globulin, Glucocorticoids, Child Health

Affiliation:

UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia, UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia



Read Full-Text article