Терапевтический архив (Apr 2011)

Clinical statistics and effectiveness of different treatments of idiopathic thrombocytopenic purpura

  • Lidiya Grigor'evna Kovaleva,
  • Elena Igorevna Pustovaya,
  • Tat'yana Isaakovna Safonova,
  • Anastasiya Aleksandrovna Ryadnenko,
  • Ekaterina Nikolaevna Kolosova,
  • L G Kovaleva,
  • E I Pustovaya,
  • T I Safonova,
  • A A Ryadnenko,
  • E N Kolosova

Journal volume & issue
Vol. 83, no. 4
pp. 60 – 65

Abstract

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Aim. To ascertain efficacy of modern treatment methods in idiopathic thrombocytopenic purpura (ITP), to characterize basic indications for administration of these methods; perspective trends in ITP therapy. Material and methods. The article presents 20-year experience in observation and treatment of 1000 ITP patients gained from 1988 by the department of standardization of blood disease treatment methods on the basis of a consultative and outpatient department of Hematological Research Center. The results were assessed by conventional ITP treatment lines. Results. First-line therapy - glucocorticoids - provided remission in 70% patients, long-term (60 months and longer) in 14%, prednisolone resistance was in 19% patients.Intravenous immunoglobulin provided a rapid hemostatic effect (in1-2 days) in all the patients. A positive response to treatment was seen in 86% patients but it was short-term (for a year and longer in 27%, resistance to the drug - 14%). Second line treatment -splenectomy - is the most effective treatment: 80% remission, 32% patients had remission for longer than 60 months. Resistance occurred in 6% patients. Ineffectiveness of treatment in 20% patients stimulated the search for new pathogenetic treatment among synthetic analogues of thrombopoietin. Clinical trials proved high efficacy of two of them - eltrombopag and romiplostim (86-87% response), possible maintenance of remission in long-term interrupted administration of low doses. Conclusion. Modern ITP treatment allows a complete management of hemorrhagic syndrome and deep thrombocytopeny in 80% patients with provision of good quality of life and ability to work. Introduction into clinical practice of thrombopoietin analogues improves treatment results including in 20% patients resistant to all treatments in the absence of marked side effects even in long-term 3-year administration of such medication.

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