Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia.
| Autor: | Elron E; Department of Neonatology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.; School of Medicine, Tel Aviv University, Tel Aviv, Israel., Yacobovich J; School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Efros O; School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Thrombosis & Hemostasis Unit, Sheba Medical Center, Tel Hashomer, Israel.; Clalit Health Services, Israel, Tel Aviv, Israel.; National Hemophilia and Thrombosis Center, Sheba Medical Center, Tel Hashomer, Israel., Tanous O; Clalit Health Services, Israel, Tel Aviv, Israel., Levy-Mendelovich S; National Hemophilia and Thrombosis Center, Sheba Medical Center, Tel Hashomer, Israel.; Amalia Biron Research Institute of Thrombosis and Hemostasis, School of Medicine, Tel Aviv University, Tel Aviv, Israel.; The Sheba Talpiot Medical Leadership Program, Tel Hashomer, Israel.; School of Medicine, Tel Aviv University, Tel Aviv, Israel., Shamba E; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Steinberg-Shemer O; School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Goldberg T; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Izraeli S; School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Gilad O; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, 14 Kaplan street, Petah Tikva 4920235, Israel.; School of Medicine, Tel Aviv University, Tel Aviv, Israel. |
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| Jazyk: | angličtina |
| Zdroj: | Therapeutic advances in hematology [Ther Adv Hematol] 2024 Sep 17; Vol. 15, pp. 20406207241279202. Date of Electronic Publication: 2024 Sep 17 (Print Publication: 2024). |
| DOI: | 10.1177/20406207241279202 |
| Abstrakt: | Objectives: Treatment of pediatric immune thrombocytopenia (ITP) is guided by the risk of bleeding. Intravenous immunoglobulin (IVIg) is one of the first-line therapy options for new-onset pediatric ITP. However, the exact optimal dose of IVIg has not been determined. Methods: This retrospective cohort study included all hospitalized children with newly diagnosed ITP receiving IVIg as first-line therapy during 2010-2020. We compared the safety and efficacy of two common IVIg dose regimens, 1 and 2 g/kg. Outcomes were short and long-term treatment responses and adverse events to the different doses. Results: A total of 168 children were included in our cohort. Eighty-two children were treated with 1 g/kg of IVIg and 86 with 2 g/kg. There was no difference in sustained response (platelet count > 20 × 10 9 , > 14 days) between the groups (74.3% vs 76.7%, respectively, p = 0.72) and maximal platelet counts following treatment ( p = 0.44). No difference was found regarding the percentage of chronic ITP between the two groups (24.4% in the 1 g/kg group as compared to 17.4% in the 2 g/kg group; p = 0.34). Logistic regression analysis demonstrated there was no effect of the IVIg dose on treatment failure and development of chronic ITP. As anticipated, 47.7% of adverse events were in the 2 g/kg group and 32.9% in the 1 g/kg group, with borderline statistical significance ( p = 0.06). Conclusion: The initial treatment of newly diagnosed pediatric ITP using a 1 g/kg IVIg regimen may give comparable results to the double dose of 2 g/kg in attaining a prolonged safe hemostatic threshold, without impacting the incidence of chronic disease. Competing Interests: Sarina Levy-Mendelovich is a recipient of research grants from Novo Nordisk and Pfizer and has an Honorium from Roche and Pfizer. The other authors have no conflicts of interest relevant to this article to disclose. (© The Author(s), 2024.) |
| Databáze: | MEDLINE |
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