Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial.

To investigate the efficacy and side effects of two different intravenous immunoglobulin (IVIG) dose regimens for the initial treatment of childhood acute immune thrombocytopenic purpura (ITP).
Thirty-four consecutive patients with a clinical diagnosis of acute ITP and a platelet count below 20x10(9)/L were randomized to receive either 1 g/kg body weight (n=17; group A) or 0.3 g/kg body weight (n=17; group B) IVIG per day for 2 consecutive days (total dose 2 g/kg and 0.6 g/kg).
Fifteen of the 17 patients (88.2%) in group A and 13 of the 17 patients (76.5%) in group B achieved a platelet count of more than 20x10(9)/L within 72 hours. The increase in platelet counts on day 2 and 3 was more pronounced in the high-dose group. Two patients in the high-dose group and four in the low-dose group were non-responders. Chronic disease occurred in three patients receiving 2 g/kg IVIG and in five patients receiving 0.6 g/kg IVIG. Side effects of IVIG administration were more common in the high-dose group.
The present study showed that platelet counts increased more rapidly after high-dose IVIG administration within the first 72 hours, although a platelet count of more than 20x10(9)/L can be achieved also with low-dose IVIG in most children with acute ITP. For patients with very low platelet counts, doses higher than 0.6 g/kg seem, therefore, to be more effective.
AuthorsMartin Benesch, Reinhold Kerbl, Herwig Lackner, Andrea Berghold, Wolfgang Schwinger, Karin Triebl-Roth, Christian Urban
JournalJournal of pediatric hematology/oncology (J Pediatr Hematol Oncol) Vol. 25 Issue 10 Pg. 797-800 (Oct 2003) ISSN: 1077-4114 [Print] United States
PMID14528103 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Immunoglobulins, Intravenous
  • Acute Disease
  • Adolescent
  • Blood Platelets (cytology, drug effects)
  • Child
  • Child, Preschool
  • Chronic Disease
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Immunoglobulins, Intravenous (administration & dosage, adverse effects, therapeutic use)
  • Immunotherapy
  • Infant
  • Male
  • Platelet Count
  • Purpura, Thrombocytopenic, Idiopathic (drug therapy, immunology, pathology)
  • Random Allocation
  • Recurrence

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