title: Comparison of anti-D immunoglobulin, methylprednisolone, or intravenous immunoglobulin therapy in newly diagnosed pediatric immune thrombocytopenic purpura.
abstract: This study aimed to evaluate the efficacy, cost, and effects of anti-D immunoglobulin (anti-D Ig), methylprednisolone, or intravenous immunoglobulin (IVIG) therapy on the development of chronic disease in children who are Rh-positive with diagnosed immune thrombocytopenic purpura (ITP). Children with newly diagnosed ITP and platelet count <20,000/mm(3) were prospectively randomized to treatment with anti-D Ig (50 μg/kg), methylprednisolone (2 mg/kg/day), or IVIG (0.4 g/kg/day, 5 days). Sixty children with a mean age of 6.7 years were divided into three equal groups. No difference was observed between platelet counts before treatment and on day 3 of treatment. However, platelet counts at day 7 were lower in the methylprednisolone group than in the IVIG group (P = 0.03). In the anti-D Ig group, hemoglobin and hematocrit levels were significantly lower at the end of treatment (P < 0.05). Chronic ITP developed in 30% of the anti-D Ig group, 35% of the methylprednisolone group, and 25% of the IVIG group, but no significant difference was noted among the groups. The cost analysis revealed that the mean cost of IVIG was 7.4 times higher than anti-D Ig and 10.9 times higher than methylprednisolone. In the treatment of ITP in childhood, one 50 μg/kg dose of anti-D Ig has similar effects to IVIG and methylprednisolone. Among patients who were treated with anti-D Ig, serious anemia was not observed, and the cost of treatment was less than that of IVIG treatment.
authors.affiliation: Sisli Etfal Hospital, Sisli, Istanbul, Turkey. mehdincelik@hotmail.com
authors.forename: Muhittin
authors.initials: M
authors.lastname: Celik
authors.forename: Ali
authors.initials: A
authors.lastname: Bulbul
authors.forename: Gönül
authors.initials: G
authors.lastname: Aydogan
authors.forename: Deniz
authors.initials: D
authors.lastname: Tugcu
authors.forename: Emrah
authors.initials: E
authors.lastname: Can
authors.forename: Sinan
authors.initials: S
authors.lastname: Uslu
authors.forename: Mesut
authors.initials: M
authors.lastname: Dursun
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D010976:Platelet Count / Q000379:methods; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*
chemical_list: D016756:Immunoglobulins, Intravenous; D018029:Rho(D) Immune Globulin; D008775:Methylprednisolone