Low-dose versus high-dose immunoglobulin for primary treatment of acute immune thrombocytopenic purpura in children: results of a prospective, randomized single-center trial.
OBJECTIVE
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.
Benesch
Martin
M
Department of Pediatrics and Adolescent Medicine, University of Graz, Austria. martin.benesch@klinikum-graz.at
Kerbl
Reinhold
R
Lackner
Herwig
H
Berghold
Andrea
A
Schwinger
Wolfgang
W
Triebl-Roth
Karin
K
Urban
Christian
C
D000208:Acute Disease; D000293:Adolescent; D001792:Blood Platelets / Q000166:cytology / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D007167:Immunotherapy; D007223:Infant; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D011897:Random Allocation; D012008:Recurrence
D016756:Immunoglobulins, Intravenous