İmmün trombositopenili erişkin hastalarda birinci basamak tedavide yüksek doz metilprednizolonun etkinliği

Year 2022, Volume: 47 Issue: 2, 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

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