Yaşar DOĞAN, Saadet AKARSU, Erdal YILMAZ, MEHMET TURGUT, M. Kaya GÜRGÖZE, MEHMET KILIÇ, A. Denizmen AYGÜN

Akut immun trombositopenik purpurda uygulanan farklı tedavilerin etkinlik ve giderleri açısından karşılaştırılması

Amaç: Akut immun trombositopenik purpura (ITP) tedavisinde uygulanan oral mega doz metilprednisolon (OMDMP) ile intravenöz immunoglobulin (İVİG)'nin tedavi etkinliği ve giderleri yönünden sonuçlarının karşılaştırması. Gereç ve Yöntem: Akut ITP tanısı alan yaşları 3-16 yıl arasında değişen 39'u erkek, 35'i kız 74 vakadan 40'ma OMDMP, 28'ine İVİG ve 6 vakaya da OMDMP ile birlikte İVİG uygulandı. Tedavinin 48. saatinde ve 7. günün sonunda hastaların trombosit sayılarına bakıldı ve hastalar bir yıl süre ile izlendi. Bulgular: Tedavi başladıktan 48 saat sonra OMDMP alan grupta ortalama trombosit sayısı 13 3,0001 mm3, İVİG alan grupta ortalama trombosit sayısı 139,0001mm3 ve kombine tedavi alan grupta ise ortalama trombosit sayısı 129,000/mm3 saptandı. Tedaviden sonra OMDMP alanların ikisinde, sadece IVIG alanların ikisinde ve kombine tedavi alanların ise birinde olmak üzere beş hastada kronik ITP gelişti. Hastalara akut dönemde uygulanan tedavi gideri 1V1G alan grupta 20 dolar/kg iken, OMDMP alan grupta ise tedavi maliyeti 0.6 dolar/kg olarak hesaplandı. Sonuç: Tedavi gideri çok yüksek olan İVİG kullanımının akut ITP tedavisinde belirgin bir üstünlüğünün olmadığı ve tedavi verilmesi gerekli olan vakalarda OMDMP tedavisinin de yeterli düzeyde etkin olduğu gözlendi, ayrıca her iki ilacın birlikte kullanımının trombosit sayısını artırması bakımından ek katkı sağlamadığı saptandı.

Anahtar Kelimeler:

Purpura, trombositopenik, idiyopatik, Çocuk, Metilprednizolon, İmmünoglobulinler, Ergen

Comparison of efficacy and costs of different treatments for acute immune idiopathic thrombacytopenic purpura

Aim: To compare the results of therapeutic efficacy and cost of oral megadose methylprednisolone (OMDMP) and intravenous immunoglobulin (IVIG) for the treatment of acute immune idiopathic thrombocytopenic purpura. Methods: Among seventy-four cases (39 male, 35 female), aged between 3-16 years, diagnosed as acute immune idiopathic thrombocytopenic purpura, fourty cases were treated with OMDMP, 28 cases with IVIQ and six cases with both of OMDMP and IVIG. At the end of 48 hours and 7 days of therapy, platelet counts were determined. The patients were followed up to one year. Results: After 48 hours of treatment, mean platelet counts were determined as 133xlO 9/L in the group who received OMDMP, 139x10 9/L in the group given IVIG and 129xl0 9IL group given OMDMP and IVIG. After treatment, chronic ITP developed in five patients; two who received OMDMP, two of who received IVIG and one who received both OMDMP and IVIG. Treatment costs were calculated to be 20 dollars/kg in the group given IVIG, and 0.6 dollars/kg in the OMDMP group. Conclusion: Although the cost of IVIG is higher for the treatment of acute immune thrombocytopenic purpura, we did not observe any superior ority and the effect of OMDMP was as efficient as IVIG. In addition, when both of those drugs were utilized together, they did not have any significant effect on increasing the thrombocyte counts.

Keywords:

Purpura, Thrombocytopenic, Idiopathic, Child, Methylprednisolone, Immunoglobulins, Adolescent,

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