Polyclonal intravenous immunoglobulin (IVIg).
Acute and chronic idiopathic thrombocytopenic purpura (ITP) in children and ITP in adults.
IVIg is highly utilized, especially in ITP. The potential availability of less costly alternative treatments for these conditions and the uncertainty of a therapeutic advantage of IVIg over alternate therapies suggest an assessment to inform decisions is necessary.
Methods and Results
Twenty-eight randomized controlled trials were identified that compared IVIg with corticosteroids, anti-D immunoglobulin, or close observation in adults and children with ITP. Most trials were of poor quality. Many trials were of limited quality.
Implications for Decision Making
- Evidence suggests IVIg can improve health in children with acute ITP. IVIg (0.8 to 1 g/kg/day over one to two days) is more efficacious than corticosteroids in terms of early improvement of thrombocytopenia to platelet counts greater than or equal to 20x109/L. The relative efficacy of IVIg in comparison with high doses of methylprednisolone of 30 mg/kg remains inconclusive.
- Compelling evidence is lacking for other indications. The role of IVIg in chronic childhood ITP could not be established. IVIg also does not have a clear advantage over other interventions for the long-term management of adult ITP.
- No evidence is available to inform some decisions. There is no relevant information available to identify subgroups of ITP patients who may preferentially benefit from IVIg.
This summary is based on a comprehensive health technology assessment available from CADTH’s web site (www.cadth.ca): Chen S, Pi D, Ansari, M, Puil L, Desjardins B, Banks R. Polyclonal Intravenous Immunoglobulin in Patients with Immune Thrombocytopenic Purpura: Clinical Systematic Review.