İmmün trombositopenili erişkin hastalarda birinci basamak tedavide yüksek doz metilprednizolonun etkinliği

Year 2022, , 715 - 721, 30.06.2022

Kaniye Aydın , Emel Gürkan

https://doi.org/10.17826/cumj.1085840

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.

Keywords

İdiyopatik trombositopenik purpura, tedavi, intravenöz immün globulin, metilprednizolon

Thanks

Ek not: Bu çalışma, tıpta uzmanlık tezimden makale haline getirilmiştir. 20. Avrupa Hematoloji Derneği (EHA) Kongresi’nde poster bildirisi olarak sunulmuştur.

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.