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A study on intravenous immunoglobulin with and without prednisolone in newly diagnosed pediatric primary immune thrombocytopenia.

Priyanka Gupta, Sumana Datta, Suprit Basu, Jyotirmoy Sen, Hasibur Rahaman Molla, Subham Bhattacharya*, Ahitagni Banerjee

Introduction: Immune Thrombocytopenic Purpura (ITP) is an immune-mediated disease characterized by a transient or persistent decrease in the platelet count. First-line agents for treatment include corticosteroids, Intravenous immunoglobulin (IVIG), and anti-D immunoglobulin (anti-D). This study was done to compare the efficacy of IVIG-prednisolone combination therapy with IVIG monotherapy in achieving sustained complete response to newly diagnosed childhood ITP.

Methodology: This was a prospective observational study conducted in the department of pediatric medicine in a tertiary care super specialty hospital in Eastern India. Children between 6 months to 12 years with newly diagnosed primary ITP with bleeding and/or platelet count <20,000/cmm were included in the study. The study population was divided into two cohorts: One cohort received IVIG at 0.8 g/kg single dose alone (IVIG cohort) and another one received IVIG in the same dose along with prednisolone 2 mg/kg/day for 14 days followed by quick tapering, maximally over 2 weeks. Both cohorts were followed up for 6 months.

Results: Complete Response (CR) was significantly higher in the IVIG-prednisolone cohort, compared to the IVIG cohort. Also, children in IVIG -prednisolone cohort maintained substantially higher median platelet count. The adverse effects in both cohorts were mild and self-limiting.

Conclusion: IVIG along with prednisolone as first-line treatment in newly diagnosed pediatric ITP is more efficacious in achieving sustained response and thus, decreasing the chronicity of the disease compared to IVIG monotherapy.