title: Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To compare the effectiveness of corticosteroids with intravenous immune globulin (IVIG) for the initial treatment of children with acute immune thrombocytopenic purpura (ITP).
  
  
  METHODS
  A systematic review and meta-analysis of randomized controlled trials comparing corticosteroids with IVIG. Studies were identified from eight electronic databases, meeting abstracts, expert consultation, and hand-searched reference lists. Two authors independently reviewed potentially eligible studies and extracted data. The number of patients with a platelet count >20,000/mm3, 48 hours after treatment initiation, was the primary outcome. Relative risks (RR) and risk differences were pooled using a random effects model, and numbers needed to treat (NNT) were calculated.
  
  
  RESULTS
  A total of 1248 abstracts were reviewed, 55 articles were retrieved, and 10 studies were included. The RR (steroids vs IVIG) of achieving a platelet count >20,000/mm3 at 48 hours was 0.74 (95% CI: 0.65, 0.85), and the NNT was 4.55 (95% CI: 3.23, 7.69).
  
  
  CONCLUSIONS
  Children treated with corticosteroids for acute ITP are 26% less likely to have a platelet count >20,000/mm3 after 48 hours of therapy, when compared with children treated with IVIG. Given the importance of low platelets in the pathogenesis of intracranial hemorrhage (ICH), this difference may hold important clinical implications.
authors.affiliation: Division of Paediatric Medicine, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada. carolyn.beck@sickkids.ca
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Beck
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.forename: Victor S
authors.initials: VS
authors.lastname: Blanchette
authors.forename: Colin
authors.initials: C
authors.lastname: Macarthur
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous