Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia
Objectives: Treatment of pediatric immune thrombocytopenia (ITP) is guided by the risk of bleeding. Intravenous immunoglobulin (IVIg) is one of the first-line therapy options for new-onset pediatric ITP. However, the exact optimal dose of IVIg has not been determined. Methods: This retrospective coh...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-09-01
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| Series: | Therapeutic Advances in Hematology |
| Online Access: | https://doi.org/10.1177/20406207241279202 |
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| author | Eyal Elron Joanne Yacobovich Orly Efros Osama Tanous Sarina Levy-Mendelovich Esti Shamba Orna Steinberg-Shemer Tracie Goldberg Shai Izraeli Oded Gilad |
| author_facet | Eyal Elron Joanne Yacobovich Orly Efros Osama Tanous Sarina Levy-Mendelovich Esti Shamba Orna Steinberg-Shemer Tracie Goldberg Shai Izraeli Oded Gilad |
| author_sort | Eyal Elron |
| collection | DOAJ |
| description | Objectives: Treatment of pediatric immune thrombocytopenia (ITP) is guided by the risk of bleeding. Intravenous immunoglobulin (IVIg) is one of the first-line therapy options for new-onset pediatric ITP. However, the exact optimal dose of IVIg has not been determined. Methods: This retrospective cohort study included all hospitalized children with newly diagnosed ITP receiving IVIg as first-line therapy during 2010–2020. We compared the safety and efficacy of two common IVIg dose regimens, 1 and 2 g/kg. Outcomes were short and long-term treatment responses and adverse events to the different doses. Results: A total of 168 children were included in our cohort. Eighty-two children were treated with 1 g/kg of IVIg and 86 with 2 g/kg. There was no difference in sustained response (platelet count > 20 × 10 9 , > 14 days) between the groups (74.3% vs 76.7%, respectively, p = 0.72) and maximal platelet counts following treatment ( p = 0.44). No difference was found regarding the percentage of chronic ITP between the two groups (24.4% in the 1 g/kg group as compared to 17.4% in the 2 g/kg group; p = 0.34). Logistic regression analysis demonstrated there was no effect of the IVIg dose on treatment failure and development of chronic ITP. As anticipated, 47.7% of adverse events were in the 2 g/kg group and 32.9% in the 1 g/kg group, with borderline statistical significance ( p = 0.06). Conclusion: The initial treatment of newly diagnosed pediatric ITP using a 1 g/kg IVIg regimen may give comparable results to the double dose of 2 g/kg in attaining a prolonged safe hemostatic threshold, without impacting the incidence of chronic disease. |
| format | Article |
| id | doaj-art-c8d5ccd1d76b4ba8a69aef582f31b906 |
| institution | OA Journals |
| issn | 2040-6215 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Hematology |
| spelling | doaj-art-c8d5ccd1d76b4ba8a69aef582f31b9062025-08-20T01:47:19ZengSAGE PublishingTherapeutic Advances in Hematology2040-62152024-09-011510.1177/20406207241279202Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopeniaEyal ElronJoanne YacobovichOrly EfrosOsama TanousSarina Levy-MendelovichEsti ShambaOrna Steinberg-ShemerTracie GoldbergShai IzraeliOded GiladObjectives: Treatment of pediatric immune thrombocytopenia (ITP) is guided by the risk of bleeding. Intravenous immunoglobulin (IVIg) is one of the first-line therapy options for new-onset pediatric ITP. However, the exact optimal dose of IVIg has not been determined. Methods: This retrospective cohort study included all hospitalized children with newly diagnosed ITP receiving IVIg as first-line therapy during 2010–2020. We compared the safety and efficacy of two common IVIg dose regimens, 1 and 2 g/kg. Outcomes were short and long-term treatment responses and adverse events to the different doses. Results: A total of 168 children were included in our cohort. Eighty-two children were treated with 1 g/kg of IVIg and 86 with 2 g/kg. There was no difference in sustained response (platelet count > 20 × 10 9 , > 14 days) between the groups (74.3% vs 76.7%, respectively, p = 0.72) and maximal platelet counts following treatment ( p = 0.44). No difference was found regarding the percentage of chronic ITP between the two groups (24.4% in the 1 g/kg group as compared to 17.4% in the 2 g/kg group; p = 0.34). Logistic regression analysis demonstrated there was no effect of the IVIg dose on treatment failure and development of chronic ITP. As anticipated, 47.7% of adverse events were in the 2 g/kg group and 32.9% in the 1 g/kg group, with borderline statistical significance ( p = 0.06). Conclusion: The initial treatment of newly diagnosed pediatric ITP using a 1 g/kg IVIg regimen may give comparable results to the double dose of 2 g/kg in attaining a prolonged safe hemostatic threshold, without impacting the incidence of chronic disease.https://doi.org/10.1177/20406207241279202 |
| spellingShingle | Eyal Elron Joanne Yacobovich Orly Efros Osama Tanous Sarina Levy-Mendelovich Esti Shamba Orna Steinberg-Shemer Tracie Goldberg Shai Izraeli Oded Gilad Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia Therapeutic Advances in Hematology |
| title | Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia |
| title_full | Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia |
| title_fullStr | Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia |
| title_full_unstemmed | Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia |
| title_short | Is less more? Intravenous immunoglobulin for pediatric immune thrombocytopenia |
| title_sort | is less more intravenous immunoglobulin for pediatric immune thrombocytopenia |
| url | https://doi.org/10.1177/20406207241279202 |
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