CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
UMR1027, Inserm, Université de Toulouse, Toulouse, France.
Eur J Haematol. 2018 May;100(5):412-418. doi: 10.1111/ejh.13032. Epub 2018 Mar 12.
To assess the benefits and harms to initiate corticosteroids with intravenous methylprednisolone at a conventional dose (1 mg/kg/d) to treat adults with immune thrombocytopenia (ITP).
Population stemmed from the prospective multicenter CARMEN registry and included newly diagnosed hospitalized ITP adults with platelet counts<30 × 10 /L. We compared the patients treated with conventional-dose methylprednisolone (CDMP) before continuing with oral prednisone to patients treated with just conventional-dose oral prednisone (CDOP). The primary outcome was the time until response. Secondary outcomes were time until complete response, response rate, complete response rate, duration of hospital stay, and occurrence of adverse drug reactions. Analyzes were adjusted for propensity score and for exposure to intravenous immunoglobulin.
Among the included 87 patients, the median time to response was 3 days in the CDMP group vs 4 in the CDOP group (adjusted hazard ratio [aHR]: 1.35; 95%CI: 0.76-2.41). The CDMP group had an earlier complete response (aHR: 2.29; 95%CI: 1.20-4.36). There was no difference between the groups regarding other secondary outcomes.
Initiating methylprednisolone at a conventional dose provided no significant benefit compared to giving oral prednisone only to adults with ITP.
评估以常规剂量（1mg/kg/d）静脉注射甲泼尼龙治疗成人免疫性血小板减少症（ITP）的获益和危害。
该研究人群来自前瞻性多中心 CARMEN 登记研究，包括新诊断的血小板计数<30×10 /L 的住院 ITP 成人患者。我们比较了接受常规剂量甲泼尼龙（CDMP）治疗后继续口服泼尼松的患者与仅接受常规剂量口服泼尼松（CDOP）治疗的患者。主要结局是达到反应的时间。次要结局是达到完全反应的时间、反应率、完全反应率、住院时间和药物不良反应的发生。分析调整了倾向评分和静脉注射免疫球蛋白的暴露情况。
在纳入的 87 例患者中，CDMP 组达到反应的中位时间为 3 天，CDOP 组为 4 天（调整后的危险比[aHR]：1.35；95%CI：0.76-2.41）。CDMP 组更早达到完全反应（aHR：2.29；95%CI：1.20-4.36）。两组在其他次要结局方面无差异。
与仅给予成人 ITP 患者口服泼尼松相比，给予常规剂量的甲泼尼龙并没有带来显著获益。
