J Korean Med Sci.  2008 Jun;23(3):445-451. 10.3346/jkms.2008.23.3.445.

Outcome of Immunosuppressive Therapy with Helicobacter pylori Eradication Therapy in Patients with Chronic Idiopathic Thrombocytopenic Purpura

• Song MK
• Chung JS
• Shin HJ
• Choi YJ
• Cho GJ

• KMID: 1786883
• DOI: http://doi.org/10.3346/jkms.2008.23.3.445

Abstract

We initiated this study to investigate whether combining Helicobacter pylori eradication with immunosuppressive therapy provides an additional benefit to patients with idiopathic thrombocytopenic purpura (ITP) that has relapsed or has not responded to steroid and/or danazol therapy in patients who have H. pylori infection. Thirty- four patients with chronic ITP that had relapsed or failed to steroid and/or danazol therapy were assessed for H. pylori infection. Of the 21 confirmed cases, 12 patients were given H. pylori eradication therapy alone (EA), while 9 patients received eradication therapy combined with immunosuppressive therapy (EI). The response rate was not significantly different between patients in the EA and those in the EI group (41.7% in the EA group vs. 66.7% in the EI group, p=0.345). The median platelet count at 6 months after therapy was higher in the EI group patients (75X10(9)/L in the EI group patients vs. 18x109/L in the EA group patients, p=0.028). The median response duration was also longer in the EI group patients (9 months in the EI group patients vs. 3 months in the EA group patients, p=0.049). These results show that a significant benefit is gained by the use of H. pylori eradication combined with immunosuppressive therapy over the use of eradication therapy alone for patients with chronic ITP.

Keyword

Helicobacter pylori; Purpura, Thrombocytopenic, Idiopathic; Eradication

MeSH Terms

Adult
Aged
Anti-Bacterial Agents/*administration & dosage
Chronic Disease
Danazol/administration & dosage
Drug Therapy, Combination
Estrogen Antagonists/administration & dosage
Female
Helicobacter Infections/complications/*drug therapy
*Helicobacter pylori
Humans
Immunosuppressive Agents/*administration & dosage
Male
Middle Aged
Purpura, Thrombocytopenic, Idiopathic/complications/*drug therapy
Steroids/administration & dosage
Treatment Outcome

Figure

• 

  Fig. 1 Flow-chart of treatment indicating the three schedules for chronic ITP patients. Round braskets, number of patients and treatment duration; EA, eradication alone; EI, eradication combined with immunosuppressive therapy; IA, immunosuppressive therapy alone.

• 

  Fig. 2 Distribution of serial platelet counts after treatment. Changes in the absolute value and median value at differential time points were measured. Serial platelet counts after therapy in the EI group (A), in the EA group (B) and in the IA group (C). -, Median platelet count at each time point.

• 

  Fig. 3 Response duration according to therapeutic setting of ITP. The response duration was longer in the EI group than the other two groups (p=0.0143). EA, eradication alone; EI, eradication combined with immunosuppressive therapy; IA, immunosuppressive therapy alone.

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