The Clinical Study Of Oseltamivir Phosphate Combined With Glucocorticoid In The Treatment Of ITP

ObjectiveTo evaluate the efficacy and safety when we use oseltamivir phosphate combined with glucocorticoid in the treatment of primary immune thrombocytopenia(ITP),and to compare whether it is better than the conventional glucocorticoid monotherapy.MethodsWe selected a total of 60 patients with ITP that admitted to the Hematology Department in the Affiliated Hospital of Taishan Medical University from October 2014 to December 2016.They were randomly divided into control group and experimental group,30 patients respectively.The control group were treated with prednisone alone,the initial dose of 1mg/(kg·d),qd.When their platelet count rose to normal or near normal range,we rapidly reduced the use of prednisone to the minimum maintenance dose 5-10mg/d within a month.If the platelet level was stable,the patients should continue the treatment with the minimum maintenance dose.The experimental group were treated by oseltamivir phosphate combined with glucocorticoid.At the start of prednisone treatment,we also gave the patients oseltamivir phosphate orally,with the dose of 75 mg,two times daily for 5 days.And the dose of prednisone,reduction standards,maintenance treatment was the same with the control group.The patients who were still invalid after treatment for 4 weeks or relapsed,for safety reasons,withdrew from this clinical study.The remaining patients were followed up for 12 weeks.The main observation indexes of this study were platelet count,effective rate and recurrence rate during different periods.The secondary observation indexes were adverse reactions,time to response,duration of efficacy.ResultsWe compared the total effective rate of the experimental group and the control group on the first day after treatment(13.3% vs 6.7%),the third day(50% vs 36.7%),the fifth day(66.7%vs53.3%)respectively,and the differences were not statistically significant(P>0.05).But the total effective rate was significantly higher in the experimental group than in the control group in the first week(80% vs 53.3%),the second week(83.3% vs 56.7%),the third week(86.7% vs 60%),and the fourth week(86.7% vs 63.3%),P<0.05.There was no significant difference between the experimental group and the control group in the complete remission rate(50% vs 36.7%)and recurrence rate(15.4% vs 21.1%)within 4 weeks(P>0.05).Follow-up to the end of 12 weeks,the total effective rate of the experimental group and the control group(46.7% vs 30%),the complete remission rate(23.3% vs 10%),the total recurrence rate(46.2% vs 52.6%)were compared,the differences were not statistically significant(P>0.05).The median of platelet counts at different time after treatment in the experimental group was much higher than that in the control group,and the difference was statistically significant(P<0.05).In the experimental group,the median time to response was shorter [3(range,1-21)days vs 5(range,1-28)days,P<0.05] and the median duration of efficacy was longer than that of the control group[63(range,0-84)days vs 35(range,0-84)days,P<0.05].As for the adverse event,one patient in the experimental group had a mild nausea and abdominal discomfort after taking oseltamivir phosphate,we gave him symptomatic treatment,then he quickly recovered.The side effects of glucocorticoid were found both in the two groups,2 patients in the experimental group and 3 patients in the control group,the number of the experimental group was less.No serious adverse events or complications occurred in both groups.ConclusionIn the clinical treatment of ITP,the method of oseltamivir phosphate combined with glucocorticoid is better than the traditional glucocorticoids monotherapy.It can improve the initial effective rate,shorten the response time,prolong the curative effect maintenance time.Besides,the method of oseltamivir phosphate combined with glucocorticoid has a good safety.However,the most suitable drug regimen,long-term efficacy needs to be further explored.