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G223 DOES TREATMENT OF CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA IN CHILDHOOD MAKE A DIFFERENCE? A SYSTEMATIC REVIEW OF RANDOMISED CONTROLLED TRIALS
EvaStuwe1, RicharCooke2, RusselKeenan1.1Royal Liverpool Childrens Hospital, Liverpool, UK; 2Liverpool Womens Hospital, Liverpool, UK
Background: The chronic form of idiopathic thrombocytopenic purpura (ITP) occurs in approximately 10–20% of children with ITP. There is no consensus on the treatment. Life threatening complications of ITP related to bleeding are uncommon but potentially devastating. Spontaneous remissions even after years have been described. No systematic review on the effect of different treatment regimes on morbidity or mortality or prevention of the chronic course of the disease has been completed so far.
Aim: To compare the effect of different treatment regimes or non-treatment on the risk of death and major haemorrhage attributable to chronic ITP and the remission rate.
Method: Randomised controlled trials (RCTs) were identified from the Cochrane Library, PubMed, Medline, Embase, Cinahl, Amed, and reference lists from identified studies and review articles. All RCTs or quasi-randomised trials on the treatment of children age 1 month to 16 years with chronic ITP, preferably comparing with a placebo group, which had data available on the set primary or secondary outcome were eligible for inclusion.
Results: Only one relevant RCT comparing intravenous IG with high-dose dexamethasone was identified and the data analysed. There was no placebo group as a control in this study. No RCT describing the effect of treatment v non-treatment on death or severe haemorrhage attributable to ITP was found. Most trials using different interventions were uncontrolled trials and therefore excluded from this review. The RCT included found no significant difference either short-term or long-term between the two treatment forms, both showed significant platelet rise shortly after first treatment (65% and 81%, respectively), but no sustained effect (25% and 9%, respectively). There was a high rate for side effects in both groups.
Conclusion: This review highlights …
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