Dilek KAÇAR, Lale OLCAY, Mehtap AKÇİL OK
The Turkish Journal of Pediatrics - 2026;68(5):741-752
Immune thrombocytopenia (ITP) is an acquired bleeding disorder in children, and the severity of the bleeding primarily guides treatment decisions. In Türkiye, the intensive seven-day mega-dose methylprednisolone (MDMP) protocol-administered as 30 mg/kg for 3 days, then 20 mg/kg for 4 days-has been used effectively for a long time. This systematic review and meta-analysis aimed to examine the efficacy of this MDMP protocol and compare it with intravenous immunoglobulin (IVIG). Researchers searched MEDLINE, Web of Science, Cochrane, and TR Dizin databases (1970-2022) and identified 11 records from Türkiye, including 6 randomized trials involving 717 patients, following PRISMA guidelines. The primary endpoint was the response rate, defined as a platelet count greater than 20x109/L. The overall response rate to MDMP across these studies was 96.1%, with 81.9% achieving a complete response. In the seven studies comparing treatments, MDMP showed a response rate of 93.6% versus 93.2% for IVIG. The meta-analysis of the six randomized studies revealed no significant difference in efficacy between the two treatments (risk ratio: 0.98; Z = -0.45; p = 0.65). While side effects were more frequent with MDMP (0.83 per patient) than with IVIG (0.41 per patient), these effects were predominantly transient (mainly weight gain in 45.3% of patients); conversely, IVIG led to acute reactions and two hospitalizations for aseptic meningitis, and no cases of thrombosis were observed with either treatment. The conclusion highlights that MDMP represents a reliable, intensive, non-biological first-line treatment for pediatric ITP, offering a practical alternative to IVIG, particularly where cost and ease of administration (oral route) are important considerations. MDMP's efficacy in achieving a rapid platelet increase is deemed similar to that of IVIG. High-quality studies are needed to confirm MDMP's long-term safety profile and definitively establish its role in managing high-grade bleeding.
