Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura

Autor:	K.W Chan, D Barnard, K Ali, Eileen Wang, Maureen Andrew, D Esseltine, S Israels, Victor S. Blanchette, M Adams, Paul Imbach, Mark L. Bernstein, James H. McMillan, Ruth Milner, N Kobrinsky, B Luke, B deVeber
Rok vydání:	1994
Předmět:	Male medicine.medical_specialty Adolescent Nausea Rho(D) Immune Globulin medicine.medical_treatment Thrombotic thrombocytopenic purpura Weight Gain Gastroenterology Drug Administration Schedule Rho(D) immune globulin Hemoglobins Isoantibodies Oral administration Prednisone Internal medicine medicine Humans Child Purpura Thrombocytopenic Idiopathic Chemotherapy Rh-Hr Blood-Group System Platelet Count business.industry Immunoglobulins Intravenous Infant General Medicine medicine.disease Thrombocytopenic purpura Surgery Child Preschool Immunoglobulin G Vomiting Female medicine.symptom business Follow-Up Studies medicine.drug
Zdroj:	The Lancet. 344:703-707
ISSN:	0140-6736
DOI:	10.1016/s0140-6736(94)92205-5
Popis:	The most serious complication of childhood acute immune thrombocytopenic purpura (ITP), intracranial haemorrhage, occurs in about 1% of children with platelet counts below 20 x 10(9)/L. We conducted a randomised study to explore three treatment options in this high-risk group. 146 children (6 months and18 years old) with typical acute ITP and platelet counts of 20 x 10(9)/L or lower were randomised to receive high-dose intravenous immunoglobulin G (IVIgG) 1 g/kg on 2 consecutive days (n = 34), 0.8 g/kg once (n = 35), intravenous anti-D 25 micrograms/kg on 2 consecutive days (n = 38), or oral prednisone 4 mg/kg per day with tapering and discontinuation of prednisone by day 21 (n = 39). The rate of response as reflected by the number of days with platelet counts at 20 x 10(9)/L or lower and the time taken to achieve a platelet count 50 x 10(9)/L or more was significantly faster for both IVIgG groups than for the anti-D group (p0.05); the difference between prednisone and IVIgG was significant (p0.05) only for the IVIgG 0.8 g/kg group, and responses to the two IgG groups were similar. These differences in response rates were reflected in the percentages of children with platelet counts of 20 x 10(9)/L or lower at 72 hours following the start of treatment: 3% (IVIgG 0.8 g/kg x 1), 6% (IVIgG 1 g/kg x 2), 18% (anti-D), and 21% (oral prednisone 4 mg/kg/day). Treatment-associated toxicities included a fall in haemoglobin with anti-D (to less than 100 g/L in 24% of cases); weight gain with oral prednisone; and fever, nausea, vomiting, and headache with IVIgG. On the basis of these results, intravenous anti-D cannot be recommended as initial therapy for children with acute ITP and platelet counts of 20 x 10(9)/L or lower. A single dose of 0.8 g/kg IVIgG offers the fastest recovery for the least treatment; additional IgG or oral prednisone can be reserved for the one-third of children who continue to have platelet counts of 20 x 10(9)/L or less at 48-72 hours after the start of treatment.
Databáze:	OpenAIRE
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