Remember what you forgot: mega dose methylprednisolone in the treatment of immune thrombocytopenia - a systematic review and meta-analysis
Abstract
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 20×109/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.
Related
- Interpreting long‐term response to rituximab in immune thrombocytopenia: Cohort construction, treatment attribution, and dynamic prognostication
- Efficacy of severe fever with thrombocytopenia syndrome vaccines in animal models: a systematic review and meta-analysis
- Treatment patterns and safety outcomes after splenectomy or thrombopoietin receptor agonists as second-line therapy for immune thrombocytopenia: Korean claims-based study.
- Treatment context is associated with thrombocytopenia report phenotypes in lung cancer: an active-comparator analysis of FAERS and JADER
- Anakinra versus intramuscular methylprednisolone acetate for gout flares in people with chronic kidney disease (ASGARD): a UK randomised multicentre, double-blind, double-dummy controlled feasibility study with economic, qualitative and safety assessment
BibTeX
@article{kacar2026remember,
title = {{Remember what you forgot: mega dose methylprednisolone in the treatment of immune thrombocytopenia - a systematic review and meta-analysis}},
author = {Dilek Kaçar and Lale Olcay and Mehtap Akçil Ok},
journal = {The Turkish Journal of Pediatrics},
year = {2026},
month = oct,
doi = {10.24953/turkjpediatr.2026.7549},
url = {https://doi.org/10.24953/turkjpediatr.2026.7549},
note = {CC BY},
}
RIS
TY - JOUR
TI - Remember what you forgot: mega dose methylprednisolone in the treatment of immune thrombocytopenia - a systematic review and meta-analysis
AU - Dilek Kaçar
AU - Lale Olcay
AU - Mehtap Akçil Ok
PY - 2026
DA - 2026/10/25
JO - The Turkish Journal of Pediatrics
DO - 10.24953/turkjpediatr.2026.7549
UR - https://doi.org/10.24953/turkjpediatr.2026.7549
AB - 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 20×109/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.
SN - 0041-4301
SN - 2791-6421
ER -