Respuesta al tratamiento de primera línea en trombocitopenia inmune primaria con corticoterapia sola o combinada
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: La trombocitopenia inmune (PTI) es una enfermedad autoinmune con un riesgo leve a grave de complicaciones hemorrágicas. El tratamiento de primera línea incluye corticosteroides, inmunoglobulinas u otros. Objetivo: Esta investigación tuvo como objetivo determinar la respuesta al tratamiento de primera línea en trombocitopenia inmune primaria con corticoterapia sola o combinada. Metodología: El estudio fue cuantitativo, analítico, retrospectivo y transversal. Se tomaron como universo y muestra 48 pacientes con diagnóstico de trombocitopenia inmune tratados con corticoterapia sola o combinada. Resultados: Al comparar los resultados del tratamiento de primera línea en pacientes con trombocitopenia inmune primaria, se encontró que de los 68 pacientes atendidos con prednisona solo el 42 tuvieron una buena respuesta y 26 no respondieron bien a ese tratamiento, estos fueron tratados con metilprednisolona de los cuales solamente 8 respondieron al tratamiento y 18 fueron tratados con inmunoglobulina. Se describieron las complicaciones, efectos adversos y casos refractarios al tratamiento de primera línea en pacientes con trombocitopenia inmune primaria, encontrando que el 18% presentaron trombocitopenia, un 4% hemorragia y un 1% insuficiencia renal y accidente cerebrovascular. Conclusión: El tratamiento de esta enfermedad es complejo y debe ser abordada de forma escalonada. Encontrando que la mejor terapia de primera línea sigue siendo el uso de corticosteroides. En pacientes resistente a los esteroides, el cambio o la suplementación de corticosteroides con inmunoglobulina mostró tasas de respuesta igualmente significativas.
Palabras clave: Inmune, Efecto adverso, Eficacia, Trombocitopenia
Background: Immune thrombocytopenia (ITP) is an autoimmune disease with a mild to severe risk of bleeding complications. First-line treatment includes corticosteroids, immunoglobulins, or others. Objective: This research aimed to determine the response to first-line treatment in primary immune thrombocytopenia with corticosteroid therapy alone or in combination. Methodology: The study was quantitative, analytical, retrospective and crosssectional. 48 patients with a diagnosis of immune thrombocytopenia treated with corticosteroid therapy alone or in combination were taken as a universe and sample. Results: When comparing the results of the first-line treatment in patients with primary immune thrombocytopenia, it was found that of the 68 patients treated with prednisone, only 42 had a good response and 26 did not respond well to this treatment, they were treated with methylprednisolone of which only 8 responded to treatment and 18 were treated with immunoglobulin. Complications, adverse effects, and cases refractory to first-line treatment were described in patients with primary immune thrombocytopenia, finding that 18% had thrombocytopenia, 4% hemorrhage, and 1% had kidney failure and stroke. Conclusion: The treatment of this disease is complex and must be approached in a stepwise manner. Finding that the best first-line therapy remains the use of corticosteroids. In steroid-resistant patients, switching or supplementation of corticosteroids with immunoglobulin showed equally significant response rates. Key words: Immune, Adverse effect, Efficacy, Thrombocytopenia
Background: Immune thrombocytopenia (ITP) is an autoimmune disease with a mild to severe risk of bleeding complications. First-line treatment includes corticosteroids, immunoglobulins, or others. Objective: This research aimed to determine the response to first-line treatment in primary immune thrombocytopenia with corticosteroid therapy alone or in combination. Methodology: The study was quantitative, analytical, retrospective and crosssectional. 48 patients with a diagnosis of immune thrombocytopenia treated with corticosteroid therapy alone or in combination were taken as a universe and sample. Results: When comparing the results of the first-line treatment in patients with primary immune thrombocytopenia, it was found that of the 68 patients treated with prednisone, only 42 had a good response and 26 did not respond well to this treatment, they were treated with methylprednisolone of which only 8 responded to treatment and 18 were treated with immunoglobulin. Complications, adverse effects, and cases refractory to first-line treatment were described in patients with primary immune thrombocytopenia, finding that 18% had thrombocytopenia, 4% hemorrhage, and 1% had kidney failure and stroke. Conclusion: The treatment of this disease is complex and must be approached in a stepwise manner. Finding that the best first-line therapy remains the use of corticosteroids. In steroid-resistant patients, switching or supplementation of corticosteroids with immunoglobulin showed equally significant response rates. Key words: Immune, Adverse effect, Efficacy, Thrombocytopenia
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Trombocitopenia inmune, Corticoterapia, Epidemiología analítica, Estudios retrospectivos, Hospital de Especialidades Dr. Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador