Purpose: To explore whether early treatment of children with idiopathic thrombocytopenic purpura (ITP) with immunoglobulin and/or corticosteroids reduces subsequent morbidity.
Design: Centers participating in a Nordic ITP study were divided according to whether they had treated more than 2/3, from 1/3 to 2/3, or less than 1/3 children within 14 days of diagnosis. The course of disease from 15 days to six months after diagnosis was compared for children managed at the three center categories. The comparison was restricted to children in whom at least one platelet count < 20 x 109/l was measured, numbering 156, 143 and 84.
Results:The three groups of children were clinically similar but were managed with initial treatment rates of 89%, 57% and 14%, respectively. By day 15, the platelet count had stabilised > 20 x 109/l in 67%, 67% and 52% (p < 0.05) and > 150 x 109/l in 38%, 29% and 29% (p < 0.20). One month after diagnosis there was no difference in recovery rates. Chronic ITP developed in 27%, 22% and 25% in the three groups. During follow-up, one or more disease-related events occurred in 23%, 22% and 19%, without any difference in the average numbers of episodes with mucosal bleeding. Treatment courses were administered to 19%, 13% and 11%, respectively.
Conclusion: Active treatment policies accelerated platelet recovery in children with short-lasting ITP but did not avert the development of chronic ITP and did not cause a reduction in morbidity during follow-up.
- corticosteroid therapy
- idiopathic thrombocytopenic purpura
- immunoglobulin therapy