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Colegio de Medicina Interna de México.

2015, Number 1

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Med Int Mex 2015; 31 (1)

Treatment of immune thrombocytopenic purpura. Experience in a single hospital

López-Hernández MA, Medina-Guzmán L, Alvarado-Ibarra M, Álvarez-Vera JL

Language: Spanish
References: 27
Page: 3-12
PDF size: 528.41 Kb.


ABSTRACT

Objective: To evaluate safety and efficacy of first and second-line treatments for immune thrombocytopenic purpura (ITP) in patients older than 15 years.
Material and method: A retrospective study was done with patients with immune thrombocytopenic purpura from January 2001 to December 2011. Treatment of first-line included: corticoids (prednisone or hydrocortisone) or immunoglobulin (IgG). Second-line: splenectomy, rituximab, immunosuppressive drugs (cyclophosphamide, azathioprine or mycophenolate) and danazol were prescribed. Respond criteria: complete (CR), platelets › 100 x 109/L; partial (PR), platelets › 30 x 109/L, without bleeding; no response, the remaining.
Results: 116 patients were included, 74% women. Mean age was 45 years (15-90). The average initial platelets were 28 x 109/L (0-90). The mean follow-up was 19 months (12-120). The corticoids were administered on 108 and IgG on 8. They were cured 59 (51%); three deaths (3%) by intracranial hemorrhage. Complications: arterial hypertension and hyperglycemia (10 and 9). Fifty-four patients received second-line treatment. The most common was splenectomy but none showed more efficiency (p=0.5). Overall final results: CR 82%, temporal remissions with relapses 10% and without remission 3%. Complications: infections, cytopenias, increase of transaminases and pancreatitis (7, 4, 2, 1). All were related to the use of immunosuppressive drugs.
Conclusions: First-line treatment is enough to cure 51% of the patients. The second-line treatments were effective in 31%. By lower toxicity, splenectomy and rituximab are preferable to immunosuppressant.


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