Open AccessPrednisone plus IVIg compared with prednisone or IVIg for immune thrombocytopenia in pregnancy: a national retrospective cohort study
Author(s) -
Xiaolu Zhu,
Ru Feng,
Qiu-Sha Huang,
Mei-Ying Liang,
Ming Jiang,
Hui Liu,
Yi Liu,
Hongxia Yao,
Lei Zhang,
Shenxian Qian,
Tonghua Yang,
Jingyu Zhang,
Xu-Liang Shen,
Linhua Yang,
Jianda Hu,
Renwei Huang,
Zhongxing Jiang,
Jingwen Wang,
Hongyu Zhang,
Zhijian Xiao,
Siyan Zhan,
HuiXin Liu,
Xinglin Wang,
YingJun Chang,
Yu Wang,
Yuan Kong,
Lei Xu,
Kai-Yan Liu,
Xiaohong Zhang,
Chenghong Yin,
Yueying Li,
Qian-Fei Wang,
Jianliu Wang,
XiaoJun Huang,
Xiaohui Zhang
Publication year - 2022
Publication title -
therapeutic advances in hematology
Language(s) - English
Resource type - Journals
eISSN - 2040-6215
pISSN - 2040-6207
DOI - 10.1177/20406207221095226
Subject(s) - prednisone , medicine , retrospective cohort study , pregnancy , pediatrics , biology , genetics
Background: The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP).Methods: Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone.Results: Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p < 0.001), and between the IVIg group (6.71 ± 4.85 days) and prednisone group ( p < 0.001). The median prednisone duration in the monotherapy group was 27 days (range, 8–195 days), whereas that in the combination group was 14 days (range, 6–85 days). No significant differences were found among these three treatment groups in neonatal outcomes, particularly concerning the neonatal platelet counts. The time to response in the combination treatment group was shorter than prednisone monotherapy. The duration of prednisone application in combination group was shorter than prednisone monotherapy. The combined therapy showed a lower predelivery platelet transfusion rate than IVIg alone.Conclusion: These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.