Efficacy of high-dose methylprednisolone as a first-line therapy in adult patients with immune thrombocytopenia

Yıl 2022, Cilt: 47 Sayı: 2, 715 - 721, 30.06.2022

Kaniye Aydın , Emel Gürkan

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

https://izlik.org/JA22NX52ZW

Öz

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.

Anahtar Kelimeler

Idiopathic thrombocytopenic purpura , treatment , intravenous immune globulin , methylprednisolone

İmmün trombositopenili erişkin hastalarda birinci basamak tedavide yüksek doz metilprednizolonun etkinliği

https://izlik.org/JA22NX52ZW

Öz

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.

Anahtar Kelimeler

İdiyopatik trombositopenik purpura , tedavi , intravenöz immün globulin , metilprednizolon

Teşekkür

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

Kaynakça

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