Randomized trial comparing intravenous immunoglobulin with methylprednisolone pulse therapy in acute idiopathic thrombocytopenic purpura

Forty-three children with newly diagnosed idiopathic thrombocytopenic purpura (ITP), platelet count (PC) below 20 x 10(9)l(-1), and either continued bleeding or failure to show a spontaneous rise in the PC after a 3 day observation period were randomized to treatment with either intravenous immunoglobulin (IVIG) infusions 1 gkg(-1) (n = 23) or intravenous methylprednisolone pulse therapy (MPPT) 30 mg kg(-1) (n = 20) on two consecutive days. After 72 h, IVIG had induced greater platelet responses (mean PC 188 x 10(9) versus 77 x 10(9)l(-1), 2p <0.001) and raised the PC to a haemostatically safe level above 50 x 10(9)l(-1) more frequently (91 versus 50%, one-sided exact p = 0.003). Children responding poorly were then given the alternative treatment in addition. After 6 days, a normal PC of over 150 x 10(9) l(-1) had been obtained more frequently in the group given first-line IVIG (70 versus 50%, p=0.16). The relapse rates during 6 months of follow-up were not significantly different (26 versus 40%, p=0.26). Cross-over treatment in 11 children with relapse confirmed the superior response to IVIG. The treatment given was restricted to the two initial infusions more often in the IVIG group (70 versus 35%, p=0.05). These results indicate that IVIG may be preferable to MPPT as the initial treatment for ITP.