Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: A systematic review and meta-analysis

Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: A systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: A systematic review and meta-analysis Xiangge Ren, Miaomiao Zhang, Xiaohan Zhang, Peidong Zhao, Wensheng Zhai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3425906/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Mar, 2024 Read the published version in BMC Pediatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Intravenous immunoglobulin (IVIg) is a first-line treatment for children with newly diagnosed immune thrombocytopenia (ITP). Higher doses of IVIg are associated with a more insupportable financial burden to pediatric patients' families and may produce more adverse reactions. Whether low-dose IVIg (LD-IVIg) can replace high-dose IVIg (HD-IVIg) has yet to be established. We conducted a comprehensive literature search from the establishment of the database to May 1, 2023, and eventually included 22 RCTs and 3 cohort studies compared different dosages of IVIg. A total of 1989 patients were included, with 991 patients in the LD-IVIg group and 998 patients in the HD-IVIg group. Our results showed no significant differences between the two groups in the effective rate (LD-IVIg: 91% vs. HD-IVIg: 93%; RR: 0.99; 95%CI: 0.96–1.02) and the durable remission rate (LD-IVIg: 65% vs. HD-IVIg: 67%; RR: 0.97; 95༅CI: 0.89–1.07). Similar results were also found in the time of platelet counts (PC) starting to rise (MD: 0.01, 95%CI: -0.06–0.09), rising to normal (MD: 0.16, 95%CI: -0.03–0.35), and achieving hemostasis (MD: 0.11, 95%CI: -0.02–0.23) between the two groups. Subgroup analysis showed the effective rate of 0.6g/kg was equal to 1g/kg subgroup (91%) but higher than 0.8g/kg subgroup (82%), and a combination with glucocorticoid may contribute to effect enhancement (combined with glucocorticoid: 91% vs. IVIg alone: 86%) whether combined with dexamethasone (92%) or methylprednisolone (91%). Besides, the incidence rate of adverse reactions in the LD-IVIg group (3%) was significantly lower than the HD-IVIg group (6%) (RR: 0.61; 95༅CI: 0.38–0.98). So low-dose IVIg (≤ 1g/kg) is effective, safe, and economical, which can replace high-dose IVIg (2g/kg) as an initial treatment. Newly diagnosed immune thrombocytopenia Intravenous immunoglobulin Children Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementalfigure.docx Supplementaltable.docx Cite Share Download PDF Status: Published Journal Publication published 21 Mar, 2024 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 29 Jan, 2024 Reviews received at journal 25 Jan, 2024 Reviewers agreed at journal 19 Jan, 2024 Reviewers agreed at journal 17 Dec, 2023 Reviews received at journal 19 Nov, 2023 Reviewers agreed at journal 13 Nov, 2023 Reviews received at journal 03 Nov, 2023 Reviewers agreed at journal 26 Oct, 2023 Reviewers invited by journal 25 Oct, 2023 Editor assigned by journal 25 Oct, 2023 Editor invited by journal 11 Oct, 2023 Submission checks completed at journal 11 Oct, 2023 First submitted to journal 09 Oct, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3425906","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":239314382,"identity":"5078b489-7378-4b6b-9de4-4506c5b410f9","order_by":0,"name":"Xiangge Ren","email":"","orcid":"","institution":"Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiangge","middleName":"","lastName":"Ren","suffix":""},{"id":239314383,"identity":"19c48e2e-4024-4936-b0ec-78fcbd9821d7","order_by":1,"name":"Miaomiao Zhang","email":"","orcid":"","institution":"Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Miaomiao","middleName":"","lastName":"Zhang","suffix":""},{"id":239314384,"identity":"d344b3c4-bf1b-4859-b43a-09a25d1b26a3","order_by":2,"name":"Xiaohan Zhang","email":"","orcid":"","institution":"Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaohan","middleName":"","lastName":"Zhang","suffix":""},{"id":239314386,"identity":"bfde8fb8-0f8a-4055-ada9-c70c0d587760","order_by":3,"name":"Peidong Zhao","email":"","orcid":"","institution":"Henan University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Peidong","middleName":"","lastName":"Zhao","suffix":""},{"id":239314388,"identity":"4b4eae47-4b3b-4703-a359-93ec16eb7e9a","order_by":4,"name":"Wensheng Zhai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCSD++IeNx769geEA0VoYZzbwyRjwHCBBCzNng5yNgUQCke6Sn91j/JlxhxmPueTzh4cLahjk+cUIWMY454yZdOGZNB7L2TkGh2ccYzCcOZuAdcwSuduYZ7Ad42G4ncNwmIeNIcHgNgEtbBK5mz/zsP3nYbh5/MFhnn9EaOGRyN0gzdvGxmNwg8HgMG8bEVokJPK/Sc44w8Yj2QP0C2+fBGG/yM9IS/7woYLNnp/9+OPPPN9s5PmlCWjBsJU05aNgFIyCUTAKsAMAUWNAlInMYnIAAAAASUVORK5CYII=","orcid":"","institution":"The first affiliated hospital of Henan University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Wensheng","middleName":"","lastName":"Zhai","suffix":""}],"badges":[],"createdAt":"2023-10-10 03:59:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3425906/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3425906/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-024-04677-3","type":"published","date":"2024-03-21T15:01:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53403882,"identity":"0403f22b-b7dc-4357-bbbf-696a0766381c","added_by":"auto","created_at":"2024-03-25 15:16:03","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1364178,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3425906/v1_covered_a3b920d0-22d2-445f-a416-b681865df1b6.pdf"},{"id":44568827,"identity":"0277c6af-e25c-4b4c-be20-4db944e1c9b8","added_by":"auto","created_at":"2023-10-13 09:57:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21628056,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalfigure.docx","url":"https://assets-eu.researchsquare.com/files/rs-3425906/v1/58719e87187d4384b5a0cf0b.docx"},{"id":44568826,"identity":"28caf85a-0605-463b-914c-63244adef8d6","added_by":"auto","created_at":"2023-10-13 09:57:38","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20196,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable.docx","url":"https://assets-eu.researchsquare.com/files/rs-3425906/v1/4e8d332488343e86a2722f90.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: A systematic review and meta-analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Newly diagnosed immune thrombocytopenia, Intravenous immunoglobulin, Children","lastPublishedDoi":"10.21203/rs.3.rs-3425906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3425906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntravenous immunoglobulin (IVIg) is a first-line treatment for children with newly diagnosed immune thrombocytopenia (ITP). Higher doses of IVIg are associated with a more insupportable financial burden to pediatric patients' families and may produce more adverse reactions. Whether low-dose IVIg (LD-IVIg) can replace high-dose IVIg (HD-IVIg) has yet to be established. We conducted a comprehensive literature search from the establishment of the database to May 1, 2023, and eventually included 22 RCTs and 3 cohort studies compared different dosages of IVIg. A total of 1989 patients were included, with 991 patients in the LD-IVIg group and 998 patients in the HD-IVIg group. Our results showed no significant differences between the two groups in the effective rate (LD-IVIg: 91% vs. HD-IVIg: 93%; RR: 0.99; 95%CI: 0.96\u0026ndash;1.02) and the durable remission rate (LD-IVIg: 65% vs. HD-IVIg: 67%; RR: 0.97; 95༅CI: 0.89\u0026ndash;1.07). Similar results were also found in the time of platelet counts (PC) starting to rise (MD: 0.01, 95%CI: -0.06\u0026ndash;0.09), rising to normal (MD: 0.16, 95%CI: -0.03\u0026ndash;0.35), and achieving hemostasis (MD: 0.11, 95%CI: -0.02\u0026ndash;0.23) between the two groups. Subgroup analysis showed the effective rate of 0.6g/kg was equal to 1g/kg subgroup (91%) but higher than 0.8g/kg subgroup (82%), and a combination with glucocorticoid may contribute to effect enhancement (combined with glucocorticoid: 91% vs. IVIg alone: 86%) whether combined with dexamethasone (92%) or methylprednisolone (91%). Besides, the incidence rate of adverse reactions in the LD-IVIg group (3%) was significantly lower than the HD-IVIg group (6%) (RR: 0.61; 95༅CI: 0.38\u0026ndash;0.98). So low-dose IVIg (\u0026le;\u0026thinsp;1g/kg) is effective, safe, and economical, which can replace high-dose IVIg (2g/kg) as an initial treatment.\u003c/p\u003e","manuscriptTitle":"Can low-dose intravenous immunoglobulin be an alternative to high-dose intravenous immunoglobulin in the treatment of children with newly diagnosed immune thrombocytopenia: A systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-13 09:57:32","doi":"10.21203/rs.3.rs-3425906/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-01-29T06:42:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-01-25T21:58:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"a87e9d7c-e3de-4f89-95c0-27ca8ec71870","date":"2024-01-19T09:55:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4a7384f5-b7a4-417f-b9c3-51514a778f5e","date":"2023-12-17T05:59:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-19T10:05:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1d3267f5-2546-4086-b512-1c8727a29c2a","date":"2023-11-13T21:18:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-11-03T12:10:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2cfb473f-03a2-437a-bafc-5aec404c6db7","date":"2023-10-26T13:31:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-25T05:28:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-10-25T05:24:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-10-11T08:54:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-10-11T08:51:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2023-10-10T03:47:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5cd12851-d08a-4df0-825f-3e1d7bb5306e","owner":[],"postedDate":"October 13th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-25T15:10:37+00:00","versionOfRecord":{"articleIdentity":"rs-3425906","link":"https://doi.org/10.1186/s12887-024-04677-3","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2024-03-21 15:01:13","publishedOnDateReadable":"March 21st, 2024"},"versionCreatedAt":"2023-10-13 09:57:32","video":"","vorDoi":"10.1186/s12887-024-04677-3","vorDoiUrl":"https://doi.org/10.1186/s12887-024-04677-3","workflowStages":[]},"version":"v1","identity":"rs-3425906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3425906","identity":"rs-3425906","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}