Comparison of Treatment Outcomes Between Intravenous Immunoglobulin and Steroid Therapy in Pediatric ITP (Idiopathic Thrombocytopenic Purpura): Intravenous Immunoglobulin and Steroid Therapy in Pediatric ITP

Zulfiqar Ali; Arif Zulqarnain; Muhammad Kamran Adil; Usman Fawad; Safwan Ahmad; Amir Hanif

doi:10.54393/pjhs.v7i3.3592

Authors

Zulfiqar Ali Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan
Arif Zulqarnain Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan
Muhammad Kamran Adil Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan
Usman Fawad Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan
Safwan Ahmad Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan
Amir Hanif Department of Pediatric Medicine and Hematology, The Children’s Hospital, The Institute of Child Health, Multan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i3.3592

Keywords:

Immunoglobulins, Purpura, Thrombocytopenic, Steroids, Treatment Outcome

Abstract

Idiopathic Thrombocytopenic Purpura (ITP) is a common and significant bleeding disorder in children with variable underlying etiologies. Objectives: To compare the short-term effectiveness and safety of IVIg versus corticosteroids in children with newly diagnosed ITP. Methods: An observational, cross-sectional comparison was conducted at a tertiary pediatric care center over a period of one year. Using consecutive sampling, 210 children were assigned to initial therapy with IVIg (n=105) or corticosteroids (n=105). Primary endpoints were time to platelet recovery and complete response by day 7; secondary endpoints included hospital stay, relapse ≤3 months, and adverse events. Group comparisons used Mann–Whitney U or chi-square/Fisher’s exact tests; multivariable logistic regression adjusted for age, gender, and baseline platelet count. Results: IVIg led to faster recovery (median 2 vs 4 days) and shorter hospital stay (3 vs 5 days), both p<0.001; higher complete response by day 7 (90.5% vs 71.4%, p<0.001); lower relapse (9.5% vs 21.0%, p=0.012) and fewer adverse events (11.4% vs 33.3%, p<0.001). IVIg independently predicted day-7 complete response (OR 4.5, 95% CI 1.9–10.8). Conclusions: In this non-randomized cohort, IVIg showed superior short-term effectiveness and safety versus corticosteroids.

References

Kühne T, Imbach P, Bolton-Maggs Ph, Berchtold W, Blanchette V, Buchanan Gr. Newly Diagnosed Idiopathic Thrombocytopenic Purpura in Childhood: An Observational Study. The Lancet. 2001 Dec; 358(9299): 2122-5. doi: 10.1016/S0140-6736(01)07219-1. DOI: https://doi.org/10.1016/S0140-6736(01)07219-1

Ghazanfar M, Sarwar H, Cheema MH, Fatima N, Sheikh AH. Spectrum of Clinical Manifestations among Pediatric and Adult Patients of Idiopathic Thrombocytopenic Purpura Presenting to Tertiary Care Hospital: Clinical Manifestations of Thrombocytopenic Purpura. Pakistan Journal of Health Sciences. 2024 May: 138-41. doi: 10.54393/pjhs.v5i05.1574. DOI: https://doi.org/10.54393/pjhs.v5i05.1574

Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper et al American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia. Blood Advances. 2019 Dec; 3(23): 3829-66. doi: 10.1182/bloodadvances.2019000966. DOI: https://doi.org/10.1182/bloodadvances.2019000966

Smith WR and Valrie C. Structural Racism and Impact on Sickle Cell Disease: Sickle Cell Lives Matter. Hematology/Oncology Clinics. 2022 Dec; 36(6): 1063-76. doi: 10.1016/j.hoc.2022.08.008. DOI: https://doi.org/10.1016/j.hoc.2022.08.008

Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T et al. Updated International Consensus Report on the Investigation and Management of Primary Immune Thrombocytopenia. Blood Advances. 2019 Nov; 3(22): 3780-817. doi: 10.1182/bloodadvances.2019000812. DOI: https://doi.org/10.1182/bloodadvances.2019000812

Jhingan A, Goel N, Singh A, Gera R, Chopra N, Mehndiratta S et al. Efficacy of Short-Course High-Dose Oral Prednisolone in Rapid Platelet Recovery for Pediatric Acute Immune Thrombocytopenic Purpura: A Prospective Cohort Study. Journal of Hematology. 2025 May; 14(3): 133. doi: 10.14740/jh2052. DOI: https://doi.org/10.14740/jh2052

Heitink-Pollé KM, Haverman L, Annink KV, Schep SJ, De Haas M, Bruin MC. Health-Related Quality of Life in Children with Newly Diagnosed Immune Thrombocytopenia. Haematologica. 2014 Sep; 99(9): 1525. doi: 10.3324/haematol.2014.106963. DOI: https://doi.org/10.3324/haematol.2014.106963

Hedlund-Treutiger I, Henter JI, Elinder G. Randomized Study of IVIg and High-Dose Dexamethasone Therapy for Children with Chronic Idiopathic Thrombocytopenic Purpura. Journal of Pediatric Hematology/Oncology. 2003 Feb; 25(2): 139-44. doi: 10.1097/00043426-200302000-00011. DOI: https://doi.org/10.1097/00043426-200302000-00011

Zhu XL, Feng R, Huang QS, Liang MY, Jiang M, Liu H et al. Prednisone Plus IVIg Compared with Prednisone or IVIg for Immune Thrombocytopenia in Pregnancy: A National Retrospective Cohort Study. Therapeutic Advances in Hematology. 2022 Apr; 13: 20406207221095226. doi: 10.1177/20406207221095226. DOI: https://doi.org/10.1177/20406207221095226

Fazal F, Zaman H, Khan Aa, Ullah A, Ikram L, Asghar A et al Frax (Fracture Risk Assessment Tool) Prediction Without BMD (Bone Mineral Density) for Assessment of Osteoporotic Fracture Risk in the General Population of Peshawar. Journal of Medical Sciences. 2025 Apr; 33(2): 67-71. doi: 10.52764/jms.25.33.2.2. DOI: https://doi.org/10.52764/jms.25.33.2.2

Neunert CE and Cooper N. Evidence-Based Management of Immune Thrombocytopenia: ASH Guideline Update. Hematology 2014, the American Society of Hematology Education Program Book. 2018 Nov; 2018(1): 568-75. doi: 10.1182/asheducation-2018.1.568. DOI: https://doi.org/10.1182/asheducation-2018.1.568

Ren X, Zhang M, Zhang X, Zhao P, Zhai W. Can Low-Dose Intravenous Immunoglobulin Be an Alternative to High-Dose Intravenous Immunoglobulin in the Treatment of Children with Newly Diagnosed Immune Thrombocytopenia: A Systematic Review and Meta-Analysis. BioMed Central Pediatrics. 2024 Mar; 24(1): 199. doi: 10.1186/s12887-024-04677-3. DOI: https://doi.org/10.1186/s12887-024-04677-3

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM et al Standardization of Terminology, Definitions and Outcome Criteria in Immune Thrombocytopenic Purpura of Adults and Children: Report from an International Working Group. Blood, The Journal of the American Society of Hematology. 2009 Mar; 113(11): 2386-93. doi: 10.1182/blood-2008-07-162503. DOI: https://doi.org/10.1182/blood-2008-07-162503

Grace RF, Despotovic JM, Bennett CM, Bussel JB, Neier M, Neunert C et al Physician Decision Making in Selection of Second‐Line Treatments in Immune Thrombocytopenia in Children. American Journal of Hematology. 2018 Jul; 93(7): 882-8. doi: 10.1002/ajh.25110. DOI: https://doi.org/10.1002/ajh.25110

Pfaundler N, Limacher A, Stalder O, Méan M, Rodondi N, Baumgartner C et al. Prognosis in Patients with Cancer‐Associated Venous Thromboembolism: Comparison of the RIETE‐VTE and Modified Ottawa Score. Journal of Thrombosis and Hemostasis. 2020 May; 18(5): 1154-61. doi: 10.1111/jth.14783. DOI: https://doi.org/10.1111/jth.14783

Heitink-Pollé KM, Uiterwaal CS, Porcelijn L, Tamminga RY, Smiers FJ, Van Woerden NL et al Intravenous Immunoglobulin vs Observation in Childhood Immune Thrombocytopenia: A Randomized Controlled Trial. Blood, The Journal of the American Society of Hematology. 2018 Aug; 132(9): 883-91. doi: 10.1182/blood-2018-02-830844. DOI: https://doi.org/10.1182/blood-2018-02-830844

Acero-Garcés DO, García-Perdomo HA. First Line Treatments for Newly Diagnosed Primary Immune Thrombocytopenia in Children: A Systematic Review and Network Meta-Analysis. Current Pediatric Reviews. 2020 Feb; 16(1): 61-70. doi: 10.2174/1573396315666191023122542. DOI: https://doi.org/10.2174/1573396315666191023122542

Qiu J, Gjini J, Arif T, Moore K, Lin M, Ghaffari S. Using Mitochondrial Activity to Select for Potent Human Hematopoietic Stem Cells. Blood Advances. 2021 Mar; 5(6): 1605-16. doi: 10.1182/bloodadvances.2020003658. DOI: https://doi.org/10.1182/bloodadvances.2020003658

Gho DS and Cooper RM. Pediatric Acute Lymphoblastic Leukemia with Hypereosinophilia and IDH2 Gene Mutation: A Case Report and Literature Review. Journal of Pediatric Hematology/Oncology. 2022 Mar; 44(2): E546-9. doi: 10.1097/MPH.0000000000002375. DOI: https://doi.org/10.1097/MPH.0000000000002375

Javalkar K, Huang Y, Lyon SM, Palfrey H, Hartz J, Chen MH et al Clinical Response to Lifestyle Counseling for Dyslipidemia and Elevated Blood Pressure in Childhood Cancer Survivors. Pediatric Blood and Cancer. 2023 Jan; 70(1): E30034. doi: 10.1002/pbc.30034. DOI: https://doi.org/10.1002/pbc.30034

Yadav DD, Singh N, Sreedharanunni S, Hira JK, Chhabra S, Trehan A et al. Extreme Genotype/Phenotype Heterogeneity of Double Heterozygous Sickle Β-Thalassemia in a Family: Implications in Antenatal Diagnosis. Indian Journal of Hematology and Blood Transfusion. 2021 Oct; 37(4): 689-91. doi: 10.1007/s12288-021-01412-1. DOI: https://doi.org/10.1007/s12288-021-01412-1