Recent trends in practice patterns and comparisons between immunoglobulin and corticosteroid in pediatric immune thrombocytopenia
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The clinical benefits and practice patterns of different pharmacologic regimes in acute pediatric immune thrombocytopenia (ITP) remain unclear in Japan. Using a national inpatient database, we analyzed recent trends in practice patterns for acute pediatric ITP, and compared risks of 6-month readmission, total hospitalization costs, and lengths of hospital stay between ITP children treated with intravenous immunoglobulin (IVIG) and corticosteroid, using inverse probability weighting analyses. From 2010 to 2014, the proportions of IVIG use increased from 43.4 to 66.0% (P trend < 0.001), while the proportions of corticosteroid use and watchful waiting decreased from 16.4 to 10% and from 28.6 to 14.3%, respectively (P trend < 0.001). No significant difference in 6-month readmission risk was observed between IVIG and corticosteroid (p = 0.28). Total length of hospital stay in the corticosteroid group was 3.5 days longer than that in IVIG (95% confidence interval, 2.1–4.6 days), whereas total hospitalization cost was greater in IVIG than in corticosteroid (difference, ¥ 207,994; 95% confidence interval, ¥ 149586–¥ 280728). A trend toward increased IVIG use was observed during the study period. Total hospitalization cost was considerably greater in the IVIG than in the corticosteroid group, whereas readmission risks were similar in both groups.
KeywordsImmune thrombocytopenia Children Corticosteroid Immunoglobulin Inverse probability weighting
Compliance with ethical standards
This work was supported by Grants from the Ministry of Health, Labour and Welfare, Japan; Ministry of Education, Culture, Sports, Science and Technology, Japan; and the Japan Agency for Medical Research and Development.
Conflict of interest
The authors have no financial relationships and no conflict of interest relevant to this article to disclose.
- 3.Kuhne T, Buchanan GR, Zimmerman S, Michaels LA, Kohan R, Berchtold W, et al. A prospective comparative study of 2540 infants and children with newly diagnosed idiopathic thrombocytopenic purpura (ITP) from the Intercontinental Childhood ITP Study Group. J Pediatr. 2003;143:605–8.CrossRefPubMedGoogle Scholar
- 10.Fujisawa K, Iyori H, Ohkawa H, Konishi S, Bessho F, Shirahata A, et al. A prospective, randomized trial of conventional, dose-accelerated corticosteroids and intravenous immunoglobulin in children with newly diagnosed idiopathic thrombocytopenic purpura. Int J Hematol. 2000;72:376–83.PubMedGoogle Scholar
- 15.Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Matsuda S. Clinical epidemiology and health services research using the diagnosis procedure combination database in Japan. Asian Pac J Dis Manag. 2013;7:1–2.Google Scholar
- 18.Rosenbaum PR, Rubin DB. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat. 2012;39:33–8.Google Scholar
- 21.Beck CE, Nathan PC, Parkin PC, Blanchette VS, Macarthur C. Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. J Pediar. 2005;147:521–7.CrossRefGoogle Scholar