Comparing the Outcomes of IVIg with Combination of IVIg and Methylprednisolone in Children with Acute Idiopathic Thrombocytopenia; a Bayesian Logistic Approach

Abstract

Background This study aimed to evaluate the effectiveness of Intravenous immunoglobulin (IVIg) and combination of IVIg and Methylprednisolone for childhood Idiopathic (autoimmune) Thrombocytopenia (ITP) treatment; in addition investigate the related factors to develop chronic form of under 15 years ITP. Materials and Methods This retrospective study conducted on 88 ITP patients that treated with IVIg or combination of IVIg and Methylpredinosolon. Children were treated with IVIg 2 mg/kg/d or combination of IVIg 2 mg/kg/d and Methylpredinosolon 20 mg/kg/d for maximum 5 days. The numbers of patients with a platelet count > 50,000/mu l, after treatment initiation, were the primary outcome. Odds Ratio (OR) as well as 95 Bayesian Credible interval (Crl), were estimated using a Bayesian Logistic regression model. Results The median age of subjects was 3.5 +/- 4.42 years (Interquartile: 2 8.5). About 13 of patients were discharged from hospitalization in day 2 and day 3. The ITP of 23 of children were progressed to chronic form. The following factors were significantly associated with the development of chronic ITP, combination of IVIg and Methylprednisolone OR: 3.24, 95% Crl: 1.06 11.11]), and day 2 and 3 of discharge from hospitalization (OR: 7.72, 95 Crl: (1.14 67.16)]. Conclusion The current results, suggest that the both IVIg and combination of IVIg are equally effective in providing a platelet level > 50,000/mu l early. In addition patients how received combination drug were more likely to develop to chronic ITP. Therefore, we suggest that this route must be preferentially used in decision making for treatment childhood ITP.