Intramuscular anti‐D immunoglobulins for home treatment of chronic immune thrombocytopenic purpura

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Abstract
To assess the efficacy of home treatment with intramuscular anti-D immunoglobulins (anti-D IgG) in patients with idiopathic or HIV-related chronic immune thrombocytopenic purpura (ITP), we conducted an open label, non-controlled, prospective study with a follow-up of 6 months in 51 consecutive patients with HTV-related (n= 24) or idiopathic ITP (n= 27). Anti-D IgG (13 μg/kg) were infused intravenously for three consecutive days (induction therapy). Patients whose platelet counts tailed to increase above 50 × 109/l were given a second course of the same therapy. If their platelet counts remained lower than 50 × 109/l, they were considered non-responsive. Patients who responded to induction therapy were injected intramuscularly with 6 μg/kg/week anti-D IgG if platelets were between 50 and 100 × 109/l or 13 μg/kg/week if they dropped to less than 50 × 109/l. After induction therapy, responses occurred in 20/24 HIV-related chronic ITP patients (83%) and in 14/27 idiopathic chronic ITP patients (52%). During follow-up, platelets remained above 50 × 109/l in 17/20 HIV-related chronic ITP patients (85%) and in 8/14 (57%) idiopathic chronic ITP patients. We conclude that anti-D IgG are a valid therapeutic option for treatment of idiopathic and HIV-related chronic ITP, since they are safe, cheap and can be given intramuscularly at home.