title: Trends in anti-D immune globulin for childhood immune thrombocytopenia: usage, response rates, and adverse effects.
abstract: In 2010, the Food and Drug Administration (FDA) added a black box warning to anti-D immune globulin (Rho(D) immune globulin, anti-D) for immune thrombocytopenia (ITP) to warn of the complications related to severe hemolysis. The objective of this retrospective medical record review was to examine recent trends in anti-D use to treat ITP and rates of adverse events in a single large pediatric hematology program. Over a 7-year period, 176 (35%) of 502 ITP patients at our center received anti-D. Anti-D was the second most commonly prescribed drug for ITP from 2003 to 2010 overall and was given first most frequently (41%). Sixty-four percent of patients responded to anti-D, but 36% had adverse effects, including five patients requiring hospitalization. From 2003 to 2010, the use of anti-D as an initial therapy for ITP significantly decreased (P < 0.001). This trend preceded the 2010 FDA black box warning. In our experience, anti-D was associated with a significant number of adverse effects when used as a treatment for ITP, although none were life-threatening. Despite recent guidelines suggesting anti-D therapy for initial treatment for ITP, anti-D therapy for ITP has significantly decreased over the past 7 years.
authors.affiliation: Division of Hematology/Oncology, Children's Hospital Boston, Massachusetts 02115, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Long
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Kalish
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.forename: Rachael F
authors.initials: RF
authors.lastname: Grace
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000453:epidemiology; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007116:Immunization, Passive; D008297:Male; D009325:Nausea / Q000139:chemically induced; D017410:Practice Guidelines as Topic; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D012189:Retrospective Studies; D018029:Rho(D) Immune Globulin / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018029:Rho(D) Immune Globulin