Elsevier

The Journal of Pediatrics

Volume 123, Issue 6, December 1993, Pages 989-995
The Journal of Pediatrics

A prospective, randomized trial of high-dose intravenous immune globulin G therapy, oral prednisone therapy, and no therapy in childhood acute immune thrombocytopenic purpura

https://doi.org/10.1016/S0022-3476(05)80400-7Get rights and content

Fifty-three children, aged 7 months to 14.4 years and with typical acute immune thrombocytopenic purpura and platelet counts ≤20 109/L, were randomly assigned to receive intravenously administered immune globulin G (IVIG), 1 gm/kg per day for 2 consecutive days (n=19); orally administered prednisone, starting at a dose of 4 mg/kg per day, with tapering and discontinuation of corticosteroids by day 21 (n=18); or no therapy (n=16). Both IVIG and prednisone resulted in significantly fewer days with platelet counts ≤20×109/L in comparison with no therapy (median, 1 and 2 days vs 4 days; corresponding ranges, 1 to 20 and 1 to 11 days vs 1 to 132 days; p<0.01). Reversal of clinically important thrombocytopenia assessed by the number of days taken to achieve a platelet count of ≥50×109/L was significantly faster in children randomly assigned to receive IVIG (median, 2 days; range, 1 to 34 days) than in those receiving prednisone (median, 4 days; range, 2 to 13 days; p<0.001) or no therapy (median, 16 days; range, 2 to 132 days; p<0.001). Because the risk of intracranial hemorrhage in children with acute immune thrombocytopenic purpura is highest in the group with severe thrombocytopenia, and appears to be restricted to children with platelet counts ≤20×109/L, these results support the use of IVIG or high doses of prednisone as initial therapy in children with acute immune thrombocytopenic purpura and severe thrombocytopenia (platelet counts ≤20×109/L).

References (25)

  • LilleymanJS

    Idiopathic thrombocytopenic purpura—where do we stand?

    Arch Dis Child

    (1984)
  • BlanchetteVS et al.

    Treatment of acute idiopathic thrombocytopenic purpura [Letter]

    J Pediatr

    (1985)
  • Cited by (237)

    • Role of immunoglobulin and antibodies in disease management

      2021, International Journal of Biological Macromolecules
    • American Society of Hematology 2019 guidelines for immune thrombocytopenia

      2019, Blood Advances
      Citation Excerpt :

      There were no RCTs that reported data on mortality, major bleeding, or overall HRQoL. For the studies that reported only 1 arm of data, 9 studies reported on durable response (7 IVIG arm,108,109,123-126,130 2 anti-D immunoglobulin arm135,136), 1 study reported on remission (1 IVIG arm123), 3 studies reported on hemolysis (yes/no) (1 IVIG arm,126 2 anti-D immunoglobulin arm135,136), 2 studies reported on mortality (1 IVIG arm,123 1 anti-D immunoglobulin arm135), 5 studies reported on major bleeding (5 IVIG arm108,109,123,126,130), and 0 studies reported on overall HRQoL. The EtD framework is shown online at https://guidelines.gradepro.org/profile/8810F037-714A-05B5-A135-A20932FAC54F.

    View all citing articles on Scopus

    Supported by a grant from the Physicians' Services Incorporated Foundation of Ontario, Canada.

    View full text