Relative Efficacy of Steroid Therapy in Ameliorating Autoimmune Thrombocytopenia Mediated by Anti-Platelet GPIIbIIIa Versus GPIbα Antibodies.
Notice bibliographique
Résumé
Abstract Abstract 1323 Poster Board I-345 Background Idiopathic thrombocytopenic purpura (ITP) is a common autoimmune disease characterized by autoantibody-induced platelet destruction and consequent bleeding disorders. Despite considerable investigation, the pathogenesis of ITP remains incompletely understood, and we currently lack a consensus for therapy. The major targeted platelet autoantigens are located on two distinctive platelet receptors; the GPIIbIIIa and GPIb complexes. It has been reported that thrombocytopenia induced by anti-GPIba antibodies, which may differ from that induced by anti-GPIIbIIIa, can be mediated via an Fc-independent pathway. We further demonstrated in a murine model that anti-GPIba-mediated-ITP is less responsive to IVIG treatment (Blood. 2006; 108(3):943-6), which is consistent with a subsequent retrospective study in human ITP patients. Since IVIG is expensive and steroid therapy is the first line of treatment for most patients, particularly in developing countries, we tested whether gluococorticosteroid therapy has equal efficacy in ITP patients caused by these two different antibodies. Patients and Methods A total of 107 ITP patients (71 females and 36 males) were recruited for the present study. Patients were first treated with Dexamethasone (DXM, 20mg/day x 3-5 days), then changed to oral administration of Prednisone (1mg/kg/day). The dose of Prednisone was gradually decreased and maintained for = 30 days. The patients were considered as responders to the therapy if no obvious haemorrhage was detected and their platelet counts were raised to = 50 × 109/L or increased by = 30 × 109/L from their original platelet count before treatment. All patients' plasma samples were collected before therapy and specific autoantibodies against GPIIbIIIa and/or the GPIb complex were measured with a monoclonal antibody immobilization of platelet antigen assay (MAIPA). Results Among the 107 patients, 23% (25/107) had antibodies against GPIIbIIIa, 18% (19/107) had antibodies against the GPIb complex, 34% (36/107) had antibodies against both the GPIIbIIIa and GPIb complex, and 25% (27/107) had no detectable antibody to either of these two antigens. We found that a majority of the patients with antibodies against GPIIbIIIa (15/22) were sensitive to the steroid therapy, which is significantly different from those with antibodies against the GPIb complex (5/19) (X2 = 7.15, P <0.01) or those with antibodies against both the GPIb complex and GPIIbIIIa (6/34) (X2 = 14.5, P <0.01). Although no statistically significant difference was observed between patients with anti-GPIb antibodies and those with both anti-GPIb and anti-GPIIbIIIa antibodies (X2 = 0.55, P >0.05), there is a tendency that patients with double positive antibodies were less responsive to steroid therapy therapy. The most sensitive patients for this therapy were those without detectable antibodies to either of these two autoantigens (21/27). Conclusions Our data suggest that anti-GPIb-mediated ITP may be less responsive to both IVIG and steroid therapies when compared to anti-GPIIbIIIa-mediated ITP. The pathogenesis and treatment of anti-GPIb-mediated ITP merits further investigation. Disclosures No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».