Glucocorticoid Versus Intravenous Immunoglobulin For The Treatment Of Acute Primary Immune Thrombocytopenia In Children: A Meta Analysis

Objective: The most common benign hemorrhagic disease of children,the pathogenesis of Primary immune thrombocytopenia(ITP)is the disorder of immune response with increased platelet destruction and decreased production.Since 80% of the cases can return to normal platelet count within 12 months after diagnosis,considering this self-limiting process in children,most children at acutestage only need first-line treatment or observation,while some need emergencytreatment,but none of these treatments have explicitly mentioned clinical treatment effect comparsion between glucocorticoid with intravenous immunoglobulin(IVIG)till now.This meta-analysis was to compare the effectiveness of glucocorticoid with IVIG as in-itial treatments of children with acute ITP.Methods: Randomized controlled trials comparing glucocorticoid withIVIG as initial treatments of children with acute ITP were systema-tically reviewed from PubMed,the Cochrane Database of SystematicReviews,the Cochrane Central Register of Controlled Trials,Chinese Biomedical Literature Database(CBM),Chinese Journal Full-text Database(CNKI),Wanfang Database and hand-searched reference lists.Quality assess-ment wasconducted by 6 items proposed by Cochrancehandbook and data were analyzed by using Rev Man 5.3 software.Results:A total of 1500 relevant articles were retrieved,and eight studies were included.Theoverall risk of bias was low in 2 trials and uncertain in6.There were 2 RCTs comparing prednisone(PDN)with intravenous immunoglobulin(IVIG)group,and 6 comparing methyprednisolone(MP)with intravenous immunoglobulin(IVIG)group among the 8RCTs comparing glucocorticoid with IVIG group.The sample size ranged from 12 to 42 with a total number of 423 patients,189 in glucocorticoid group,and 189 in IVIG group.The outcomes analysis show:①The RR(glucocorticoid vs IVIG)of achieving a platelet count >20×10~9/L at 48 h was 0.77(95% CI: 0.67~0.89).Subgroup analysissuggested significant difference between methylprednisolone(MP)at a dose of 30mg/kg and IVIG 1g/kg/d×2d(RR=0.66,95% CI:0.47~0.91),as well as between predisone(PDN)at a dose of 4mg/kg and IVIG 1g/kg/d×2d(RR=0.79,95%CI: 0.66~0.95).②The RR(glucocorticoid vs IVIG)of achieving a platelet count >20×10~9/L at24,72 h was 0.69(95% CI: 0.53~0.91)and 0.82(95%CI: 0.74~0.90)respectively.③The RR(glucocorticoid vs IVIG)of achieving a plate let count >50×10~9/L at 24,48,72 h was 0.38(95%CI:0.21~0.69),0.53(95% CI: 0.41~0.69)and 0.80(95% CI: 0.70~0.93)respectively.④The incidence rate of splenectomy of glucocorticoid did not differfrom IVIG(RR=5.41,95% CI: 0.95~30.74,P=0.06).Conclusions:①Children treated with glucocorticoid for acute ITP were 23% less likely to have a platelet count >20×10~9/L after 48h of therapy,whenc ompared with children treated with IVIG.②AS initial treatment of children with acute ITP,IVIG was more effictive than glucocorticoid in increasing the platelet count to above 50×10~9/L after 24,48,and 72h of therapy.