İmmün trombositopenili erişkin hastalarda birinci basamak tedavide yüksek doz metilprednizolonun etkinliği
Abstract
Amaç: İmmün trombositopenili (İTP) erişkin hastalarda birinci basamak tedavi olarak yüksek doz metilprednizolon (HDP) ile intravenöz immünoglobulin (İVİG) ve konvansiyonel prednizolonun (CDP) etkinliğini karşılaştırmayı amaçladık.
Gereç ve Yöntem: Bu retrospektif çalışma, daha önce tedavi edilmemiş yeni tanı konmuş İTP (n=51) veya epizodları olan kalıcı (n=22) ya da kronik İTP (n=67)’li 140 yetişkin hastayı içermektedir. Trombosit sayısı <30x109/L veya <50x109/L olan ve klinik olarak anlamlı kanaması olan hastalar ya CDP tedavisi (yanıta kadar 1 mg/kg/gün) ya da HDP (3 gün boyunca 20 mg/kg/gün) ya da İVİG (2 gün boyunca 1g/kg/gün) ile tedavi edilmiştir. Tüm gruplardaki hastalar trombosit sayıları stabilize olana kadar oral prednizolon (1 mg/kg/gün) ile tedaviye devam etti. Tedaviden sonra hastaların yanıtları ve klinik seyirleri değerlendirildi.
Bulgular: Başlangıç trombosit sayıları tüm gruplarda benzerdi. 92'sine (%65.7) HDP, 32'sine (%22.8) İVİG ve 16'sına (%11.4) CDP verildi. HDP grubu, İVİG ve CDP gruplarından daha erken ilk yanıt gösterse de, ilk yanıttaki medyan trombosit sayısı tüm gruplarda benzerdi. HDP grubunda (%57.6), İVİG (%37.5) ve CDP (%25.0) gruplarına göre uzun süreli remisyon daha yüksekti ve bunların nüks oranları sırasıyla %62.8, %81.3 ve %88.9 idi.
Sonuç: Sonuçlar, HDP'nin göreceli etkinliği, düşük maliyeti ve kullanım kolaylığının, onu İTP'li yetişkin hastalar için birinci basamak tedavi olarak önermeye devam ettiğini göstermektedir.
Thanks
Ek not: Bu çalışma, tıpta uzmanlık tezimden makale haline getirilmiştir. 20. Avrupa Hematoloji Derneği (EHA) Kongresi’nde poster bildirisi olarak sunulmuştur.
References
- Abrahamson PE, Hall SA, Feudjo-Tepie M, et al. The incidence of idiopathic thrombocytopenic purpura among adults: a population based study and literature review. Eur J Haematol. 2009;83(2):83-89.
- Schoonen WM, Kucera G, Coalson J, et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol. 2009;145(2):235-44.
- Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost. 2006;4(11):2377-83.
- Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J Hematol. 2010;85(3):174-80.
- Yong M, Schoonen WM, Li L, Kanas G,et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. Br J Haematol.2010;149(6):855-64.
- Kistangari G, McCrae KR. Immune thrombocytopenia. Hematol Oncol Clin North Am. 2013; 27:495-520.
- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-66.
- Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12;113(11):2386-93.
- Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817.
- Godeau B, Chevret S, Varet B, et al; French ATIP Study Group. Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone, for adults with untreated severe autoimmune thrombocytopenic purpura: a randomised, multicentre trial. Lancet. 2002 Jan 5;359(9300):23-9.
- Kim CH, Choi YS, Moon JY, et al. Methylprednisolone versus intravenous immune globulin as an initial therapy in adult primary immune thrombocytopenia. Korean J Intern Med. 2019 Mar;34(2):383-89.
- Mazzucconi MG, Fazi P, Bernasconi S, et al; Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) Thrombocytopenia Working Party. Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood. 2007 Feb 15;109(4):1401-7.
- Cheng Y, Wong RS, Soo YO, et al. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med. 2003 Aug 28;349(9):831-6.
- Borst F, Keuning JJ, van Hulsteijn H, et al. High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults. Ann Hematol. 2004 Dec;83(12):764-8.
- Mashhadi MA, Kaykhaei MA, Sepehri Z, Miri-Moghaddam E. Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru. 2012 Aug 28;20(1):7.
- Provan D, Stasi R, Newland AC,et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168-86.
Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with immune thrombocytopenia
Abstract
Purpose: We aimed to compare the efficacy of high-dose methylprednisolone (HDP) with intravenous immunoglobulin (IVIG) and conventional prednisolone (CDP) as a first-line therapy in adult patients with immune thrombocytopenia (ITP).
Materials and Methods: This retrospective study included 140 adult patients with either previously untreated newly diagnosed ITP (n=51) or persistent or chronic ITP (n=22/n=67)) with episodes. Patients with a platelet count <30x109/L or <50x109/L with a clinically significant bleeding were treated either by CDP therapy (1mg/kg/d until response) or HDP (20 mg/kg/d for 3 d) or IVIG (1g/kg/d for 2 d). The patients in all groups continued treatment with oral prednisolone (1 mg/kg/d) until their platelet counts stabilized. After therapy, patients’ responses and clinical courses were evaluated.
Results: The initial platelet counts were similar in all groups. HDP was given to 92 patients (65.7%), IVIG to 32 (22.8%), and CDP to 16 (11.4%). Although the HDP group showed a first response sooner than the IVIG and CDP groups, the median platelet count at first response was similar in all groups. Long-term remission was greater in the HDP group (57.6%) than in the IVIG (37.5%) and CDP (25.0%) groups, and their respective recurrence rates were 62.8%, 81.3% and 88.9%.
Conclusion: Our results indicate that HDP’s relative effectiveness, low cost, and convenience of use continue to recommend it as a first-line therapy for adult patients with ITP.
Keywords
Idiopathic thrombocytopenic purpura treatment intravenous immune globulin methylprednisolone
References
- Abrahamson PE, Hall SA, Feudjo-Tepie M, et al. The incidence of idiopathic thrombocytopenic purpura among adults: a population based study and literature review. Eur J Haematol. 2009;83(2):83-89.
- Schoonen WM, Kucera G, Coalson J, et al. Epidemiology of immune thrombocytopenic purpura in the General Practice Research Database. Br J Haematol. 2009;145(2):235-44.
- Segal JB, Powe NR. Prevalence of immune thrombocytopenia: analyses of administrative data. J Thromb Haemost. 2006;4(11):2377-83.
- Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN. The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J Hematol. 2010;85(3):174-80.
- Yong M, Schoonen WM, Li L, Kanas G,et al. Epidemiology of paediatric immune thrombocytopenia in the General Practice Research Database. Br J Haematol.2010;149(6):855-64.
- Kistangari G, McCrae KR. Immune thrombocytopenia. Hematol Oncol Clin North Am. 2013; 27:495-520.
- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-66.
- Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009 Mar 12;113(11):2386-93.
- Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817.
- Godeau B, Chevret S, Varet B, et al; French ATIP Study Group. Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone, for adults with untreated severe autoimmune thrombocytopenic purpura: a randomised, multicentre trial. Lancet. 2002 Jan 5;359(9300):23-9.
- Kim CH, Choi YS, Moon JY, et al. Methylprednisolone versus intravenous immune globulin as an initial therapy in adult primary immune thrombocytopenia. Korean J Intern Med. 2019 Mar;34(2):383-89.
- Mazzucconi MG, Fazi P, Bernasconi S, et al; Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA) Thrombocytopenia Working Party. Therapy with high-dose dexamethasone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood. 2007 Feb 15;109(4):1401-7.
- Cheng Y, Wong RS, Soo YO, et al. Initial treatment of immune thrombocytopenic purpura with high-dose dexamethasone. N Engl J Med. 2003 Aug 28;349(9):831-6.
- Borst F, Keuning JJ, van Hulsteijn H, et al. High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults. Ann Hematol. 2004 Dec;83(12):764-8.
- Mashhadi MA, Kaykhaei MA, Sepehri Z, Miri-Moghaddam E. Single course of high dose dexamethasone is more effective than conventional prednisolone therapy in the treatment of primary newly diagnosed immune thrombocytopenia. Daru. 2012 Aug 28;20(1):7.
- Provan D, Stasi R, Newland AC,et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010 Jan 14;115(2):168-86.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2022 |
| Acceptance Date | May 2, 2022 |
| Published in Issue | Year 2022 Volume: 47 Issue: 2 |
