Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
J Vet Intern Med. 2024 Jul-Aug;38(4):1982-2007. doi: 10.1111/jvim.17079. Epub 2024 May 23.
Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.
犬猫免疫性血小板减少症（ITP）的管理正在不断发展，但目前尚无循证指南可协助临床医生做出治疗决策。同样，ITP 的总体治疗目标也尚未确定。免疫抑制剂量的糖皮质激素是一线治疗药物，但糖皮质激素以外的最佳治疗方案仍不确定。其他选择包括二线免疫抑制药物，如阿扎胞苷、环孢素 A 改性制剂和霉酚酸酯，通常根据临床医生的偏好进行选择。长春新碱、人静脉注射免疫球蛋白（hIVIg）和输注富含血小板或红细胞的产品通常用于更严重的病例。脾切除术和血小板生成素受体激动剂通常保留用于难治性病例，但何时以及在哪些患者中应采用这些方法仍存在争议。为了制定针对 ITP 患者个体化治疗的循证指南，我们提出了 20 个基于人群的干预比较结局（PICO）格式的问题。这些问题由 17 名证据评估员使用通过结构化搜索策略确定的 288 篇文献的文献库来解答。证据评估员使用小组设计的模板和数据提取工具总结证据并制定指南建议。这些建议由治疗领域主席进行整合，然后通过迭代 Delphi 调查审查进行细化，以就最终指南达成共识。此外，19 个非 PICO 问题涵盖了证据不足或质量较低的情况，这些问题通过使用小组集成和细化的迭代 Delphi 调查来征求专家意见进行解答。在最终确定共识之前，还向多个相关专业组织征求了意见。严格的共识过程确定了很少有比较治疗研究，这突出了 ITP 治疗中许多需要进一步研究的领域。本声明是与 ACVIM 犬猫免疫性血小板减少症诊断共识声明的配套文件。
