Korean J Intern Med.  2019 Mar;34(2):383-389. 10.3904/kjim.2015.070.

Methylprednisolone versus intravenous immune globulin as an initial therapy in adult primary immune thrombocytopenia

• Kim CH
• Choi YS
• Moon JY
• Kim DY
• Lee SY
• Lee HJ
• Yun HJ
• Kim S
• Jo DY
• Song IC

• KMID: 2441018
• DOI: http://doi.org/10.3904/kjim.2015.070

Abstract

BACKGROUND/AIMS
Few studies have addressed whether there are differences in clinical efficacy between intravenous methylprednisolone (methyl-Pd) and intravenous immunoglobulin (IVIg) use.
METHODS
We retrospectively compared platelet responses and toxicities associated with these two treatments in adult patients with immune thrombocytopenia. Patients received intravenous methyl-Pd therapy followed by oral prednisolone (Pd) from 1993 to 2002 and IVIg together with oral Pd from 2003 to 2008.
RESULTS
Early response and maintenance of the response were assessed at 7 days and 6 months after treatment, respectively. Of the 87 patients enrolled, 77 (88.5%) were eligible for analysis. Early responses occurred in 30 of 39 patients (76.9%) receiving methyl-Pd versus 33 of 38 patients (86.6%) receiving IVIg (p = 0.187). The response was maintained in 28 patients (71.8%) in the methyl-Pd arm and in 23 patients (60.5%) in the IVIg arm (p = 0.187). The time to a complete response in the IVIg arm (6 days; range, 1 to 35) was shorter than that in the methyl-Pd arm (13.5 days; range, 2 to 29) (p = 0.002). Side effects were mild and tolerable in both arms. Five years after initiating treatment, 7 of 18 patients (38.9%) and five of 14 patients (35.7%) were still maintaining a response in the methyl-Pd and IVIg arms, respectively.
CONCLUSIONS
These results indicate that neither the early response rate nor the long-term outcome differed between the methyl-Pd and IVIg treatments. However, IVIg induced a complete response more rapidly than did methyl-Pd.

Keyword

Immune thrombocytopenia; Methylprednisolone; Intravenous immunoglobulins

MeSH Terms

Adult*
Arm
Blood Platelets
Humans
Immunoglobulins
Immunoglobulins, Intravenous*
Methylprednisolone*
Prednisolone
Purpura, Thrombocytopenic, Idiopathic*
Retrospective Studies
Treatment Outcome
Immunoglobulins
Immunoglobulins, Intravenous
Methylprednisolone
Prednisolone