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

Abstract

PURPOSE:

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).

METHODS:

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).

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Martin Benesch, Reinhold Kerbl, Herwig Lackner, Andrea Berghold, Wolfgang Schwinger, Karin Triebl-Roth, Christian Urban
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) Vol. 25 Issue 10 Pg. 797-800 (Oct 2003) ISSN: 1077-4114 [Print] United States
• PMID: 14528103 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Immunoglobulins, Intravenous

Topics

• 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