The efficacy of different dose intravenous immunoglobulin in treating acute idiopathic thrombocytopenic purpura: a meta-analysis of 13 randomized controlled trials

Abstract

The purpose of this study was to compare the effects of different dose intravenous immunoglobulin for treatment of acute idiopathic thrombocytopenic purpura. Randomized controlled trials (RCTs) comparing high-dose intravenous immunoglobulin (HD-IVIG) with low-dose intravenous immunoglobulin (low-IVIG) for acute idiopathic thrombocytopenic purpura (ITP) were identified using a predefined search strategy. Effective rate, time of cessation of bleeding, time of platelet count beginning to rise, platelet count by the first week of treatment, the number of platelets after 2 weeks of treatment, time of platelet count to reach peak, peak value of platelet count after treatment, side-effects and rate of developing into chronic ITP were extracted and compared by RevMan 4.2.8 (The Cochrane Collaboration, Oxford, UK). Thirteen RCTs (646 patients) were identified. Meta-analysis showed that effective rate, time of cessation of bleeding, time of platelet count beginning to rise, platelet count by the first week of treatment, the number of platelets after 2 weeks of treatment, time of platelet count to reach peak, peak value of platelet count after treatment and rate of developing into chronic ITP were not statistically different between the two different treatment administrations. However, low-IVIG was associated with a significantly reduced risk of side-effects {odds ratio (OR) 0.39 [95% confidence interval (CI) 0.18-0.83]; P = 0.01]. In conclusion, low-IVIG can be performed as effectively as HD-IVIG without increasing the rate of developing into chronic ITP. Furthermore, the low-IVIG regimen can have fewer side-effects than HD-IVIG administration in patients with acute ITP.