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Clinical value of different anti-D immunoglobulin strategies for preventing Rh hemolytic disease of the fetus and newborn: A network meta-analysis
Xie X, Fu Q, Bao Z, Zhang Y, Zhou D
PLoS One. 2020;15(3):e0230073
Abstract
BACKGROUND Several anti-D immunoglobulin strategies exist for preventing Rh hemolytic disease of the fetus and newborn. This study systematically assessed the clinical value of those therapeutic strategies. METHODS The Web of Science, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched for eligible studies that evaluated the value of different anti-D immunoglobulin strategies in preventing maternal anti-D antibody sensitization. Combined odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. The network meta-analysis was conducted using Stata 14.2 and WinBUGS 1.4.3 software. RESULTS Twenty-four original studies involving 64860 patients were included. Among all therapeutic measures, injecting 300 mug anti-D immunoglobulin at 28 and 34 gestational weeks (antenatal 5/E) appeared to be the most effective measure for preventing maternal antibody sensitization (surface under the cumulative ranking curve [SUCRA] = 96.8%), while a single injection at 28 gestational weeks (SUCRA = 89.2%) was the second most effective. Administering no injection or a placebo (SUCRA = 0.0%) was the least effective intervention measure. CONCLUSION Among the therapeutic measures, antenatal 5/E appeared to be the best method for reducing the positive incidence of anti-D antibodies in the maternal serum; thus, it may be the most effective treatment for preventing fetal hemolytic disease.
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2.
First line treatments for newly diagnosed primary immune thrombocytopenia in children: a systematic review and network meta-analysis
Acero-Garces DO, Garcia-Perdomo HA
Current pediatric reviews. 2019
Abstract
BACKGROUND The first-line interventions in immune thrombocytopenia (ITP) consist in intravenous polyclonal immunoglobulins (IVIg), corticosteroids and anti-D immunoglobulin (anti-D). OBJECTIVE We aimed to compare the effectiveness and safety of first line treatments for newly-diagnosed primary ITP in children to increase the platelet count. METHODS We searched MEDLINE, EMBASE, LILACS, and the Cochrane Central register of Controlled Trials (CENTRAL); we included clinical trials. We performed the statistical analysis in R. RESULTS We included 12 studies for meta-analysis. Compared with IVIG 2g/kg, response rates were lower for prednisone 2mg/kg at 72 hours [RR 0.04 (95% CI 0.0 to 0.68)] and at 7 days [RR 0.23 (95% CI 0.08 to 0.67)]; at 48 hours, methylprednisolone 30mg/kg also showed lower response rates [RR 0.72 (95% CI 0.52 to 0.99)]. IVIG 2g/kg and 2.5g/kg had less adverse effects than Anti-D, methylprednisolone and IVIG 0.8g/kg. For rising platelet count, no statistical differences were found at 24 hours or at 7 days; at 48 hours, IVIG 2g/kg showed better results than Anti-D 75microg/kg [MD -58.84 (95% CI -87.02 to -25.66)]. At one month, platelet count with IVIG 2g/kg was higher than Anti-D 50 and 75microg/kg [-82.03 (95% CI -102.60 to -61.46) and -78.77 (95% CI -97.80 to -59.74), respectively], but lower than methylprednisolone 50mg/kg [MD 118 (95% CI 3.88 to 232.12)]. CONCLUSION The total platelet count rises higher in early and late phases with IVIG than Anti-D, but in long term it is higher with methylprednisolone. Additionally, IVIG causes less adverse effects than Anti-D and corticosteroids.
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3.
Efficacy and Safety of Anti-D Immunoglobulins versus Intravenous Immunoglobulins for Immune Thrombocytopenia in Children: Systematic Review and Meta-analysis of Randomized Controlled Trials
Lioger B, Maillot F, Ternant D, Passot C, Paintaud G, Bejan-Angoulvant T
The Journal of Pediatrics. 2018;204:225-233 e8.
Abstract
OBJECTIVES To compare the efficacy and safety of intravenous immunoglobulins (IVIG) and anti-D immunoglobulin (anti-D) in pediatric immune thrombocytopenia (ITP). STUDY DESIGN We conducted a systematic review and meta-analysis following PRISMA guidelines, including all randomized controlled trials that have assessed the efficacy and safety of anti-D and IVIG in children with ITP. We searched Medline, Embase, and Cochrane databases. Primary outcomes were the proportion of children achieving platelet count responses as defined in each study and bleeding response. Other safety outcomes included infusion reactions and hemolysis. RESULTS Eleven studies with 558 children were included. Anti-D was significantly inferior to IVIG at increasing platelet counts, both for thresholds of >20 x 10(9)/L at 24-72 hours (response rate ratio for anti-D vs IVIG 0.85, 95% CI 0.78-0.94) and >50 x 10(9)/L at 24-72 hours (response rate ratio for anti-D vs IVIG 0.75, 95% CI 0.61-0.92). Bleeding response was assessed in 4 studies, but some heterogeneity in reporting leads to unclear conclusion. General symptoms after anti-D infusion were less frequent than after IVIG (Peto OR 0.39, 95% CI 0.25-0.62). Hemolysis was more frequent after anti-D. The overall quality of the studies was low. CONCLUSIONS Compared with anti-D, IVIG led to a better response in terms of platelet count and may be preferred as a first-line treatment of ITP in children with acute hemorrhagic symptoms. However, the clinical significance of IVIG superiority on platelet count remains unclear.
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4.
Clinical effect of anti-D immunoglobulin in treatment of childhood immune thrombocytopenia: a meta analysis
Qin W, Huang SL, Li TT
Zhongguo Dang Dai Er Ke Za Zhi = Chinese Journal of Contemporary Pediatrics. 2017;19((10)):1070-1076.
Abstract
OBJECTIVE To investigate the clinical effect and safety of anti-D immunoglobulin (anti-D) in the treatment of children with newly diagnosed acute immune thrombocytopenia (ITP) through a Meta analysis. METHODS PubMed, EMBASE, Cohrane Library, Ovid, CNKI, and Wanfang Data were searched for randomized controlled trials (RCTs) published up to April 2017. Review Manager 5.3 was used for the Meta analysis. RESULTS Seven RCTs were included. The Meta analysis showed that after 72 hours and 7 days of treatment, the intravenous immunoglobulin (IVIG) group had a significantly higher percentage of children who achieved platelet count >20x109/L than the anti-D group (P<0.05). There were no significant differences in platelet count after 24 hours, 72 hours, and 7 days of treatment between the anti-D (50 mug/kg) group and the IVIG group (P>0.05), and there were also no significant differences in platelet count after 24 hours and 7 days of treatment between the 50 mug/kg and 75 mug/kg anti-D groups (P>0.05). The anti-D group had a significantly greater reduction in the hemoglobin level than the IVIG group after treatment, but did not need transfusion. No children in the anti-D group or the IVIG group experienced serious adverse reactions. CONCLUSIONS Intravenous injection of anti-D may have a similar effect as IVIG in improving platelet count in children with acute ITP, but it may be slightly inferior to IVIG in the rate of platelet increase after treatment. The anti-D dose of 50 mug/kg may have a similar effect as 75 mug/kg. The recommended dose of anti-D for treatment of ITP is safe.
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5.
Cost-effectiveness of treatment for acute childhood idiopathic thrombocytopenic purpura (ITP) - a systematic review
Chen M, Zhang LL, Hu M, Gao J, Tong RS
Journal of International Medical Research. 2008;36((3):):572-8.
Abstract
The cost-effectiveness of treatment for acute paediatric idiopathic thrombocytopenic purpura (ITP) was assessed to provide evidence for health-care decision making and rational drug use. A systematic review of studies published between 1980 and 7 September 2007 on the clinical effects and economic profiles of treating ITP was undertaken. The quality of the studies was critically appraised and checklists were developed to assess methodological quality and transferability to the Chinese setting. Out of 174 studies, five (one Chinese; four USA) satisfied all the predefined criteria for inclusion and form the basis of this report. Methodological quality of most of the foreign studies was high, but transferability to other countries was low. Use of steroids provided additional life years and was cost-effective compared with intravenous immunoglobulin G and anti-D immunoglobulin. In comparison, the quality of the Chinese studies was low and long-term research rare. It was difficult to compare cost-effectiveness in different health-care settings and no lifetime economic evaluations were available.