Study | Level of evidence, study design, and methodological quality | Study population (range) | Intervention and comparator | Outcome and adverse events (range) | Statistical comparison (P value or [95% Cl]) |
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Kohn et al. [7] | LOE 3 Prospective case series Very small number of dogs in each group Uncertain enrollment | 15 client-owned dogs with a diagnosis of ITP with a mean initial platelet count of 10,400/µL (0–74,000/µL) 13 dogs reached the outcome | Treatment during beginning of disease: Tx1: Prednisolone 1–1.5 mg/kg BID Tx2: Prednisolone 1–1.5 mg/kg BID + Aza 1,5-2 mg/kg SID Tx3; Prednisolone 1–1.5 mg/kg BID + Aza 1.5-2 mg/kg SID (4–7 days after Vinc Inj) + Vinc 0.5 mg/m2 once or possibly after 1 week | Platelet recovery > 50.000/µL: Tx1: 1, 2, 3, 3, 4, 5 and 9 days Tx2: 3, 3 and 11 days Tx3: 2, 3 and 5 days Platelet recovery > 150,000/µL: Tx1: 3, 5, 6, 6, 6, 11 and 13 days Tx2: 6, 10 and 22 days Tx3: 4, 5 and 13 days Adverse events: Tx2 and Tx3: Grade 5 death | No statistical evaluation of outcome |
Balog et al. [14] | LOE 1+ (Randomized), multicenter, blinded, clinical trial Small number of dogs in each group Uncertain enrollment | 20 client-owned dogs with a diagnosis of severe primary ITPwith a median initial platelet count of 1000/µL (0–16,000/µL) | Treatment within 24 h of initial presentation to day 7: Tx1: Prednisone 1.5-2 mg/kg BID or Dex 0.2–0.3 mg/kg SID + hIVIG 0.5 g/kg once C: Prednisone 1.5-2 mg/kg BID or Dex 0.2–0.3 mg/kg SID + Vinc 0.02 mg/kg once Adjunctive treatment after day 7 if no platelet recovery occurred: Alternative drug (VINC or hIVIG) + Aza 2 mg/kg SID | Platelet recovery ≥ 40,000/µL: Tx1: median 2.5 days (0–10 days) C: median 2.5 days (1–4 days) Duration of hospitalizationa: Tx1: median 5 days (1.5–10 days) C: median 4 days (3–5 days) Survival to discharge: Tx1: 70% C: 100% Survival 6-month: Tx1: 22% C: 70% Survival 1-year: Tx1: 22% C: 60% Adverse events: Tx1 and C: Grade 1 mild | No significant difference (P < 0.05) in platelet recovery time (P = 0.51), duration of hospitalization (P = 0.29), survival to discharge (P = .21), survival 6-months (P = 0.17) and survival 1-year (P = 0.07) between groups |
Bianco et al. [26] | LOE 1++ Randomized, double-blinded, placebo-controlled, clinical trial Very small number of dogs in each group Strongly supportive enrollment | 18 client-owned dogs with a presumptive diagnosis of primary ITP with a median initial platelet count of 2000/µL (1000–18,000/µL) | Treatment within 24 h of initial presentation to day 7: Tx1: Prednisone 1.5 mg/kg BID + hIVIG 0.5 g/kg once C: Prednisone 1.5 mg/kg BID + Placebo (0.9% NaCl) Adjunctive treatment on day 7 if no platelet recovery occurred or to decrease dosage of prednisone: Alternative drug (Placebo or hIVIG) + Aza 2 mg/kg SID, Vinc 0.02 mg/kg once and Cyclo 5 mg/kg BID in different combinations | Platelet recovery > 40,000/µL: Tx1: median 3,5 days (2–7 days) mean 3.7 ± 1.3 days SD C: median 7.5 days (3–12) mean 7.8 ± 3.9 days SD Duration of hospitalizationb: Tx1: median 4 days (2–8) mean 4.2 ± 0.4 days SD C: median 8 days (4–12) mean 8.3 ± 0.6 days SD Platelet recovery > 160,000/µL: Tx1: median 8 days (3–19) C: median 13 days (5–32) Survival to discharge: Tx1: 100% C: not described Survival 6-month: Tx1:100% C:78% Relapse during 6-monthc: Tx1: 11% C: 11% Adverse events: Tx1: Grade 1 mild C: Grade 1 mild | Significant difference (P < 0.05) in platelet recovery time > 40,000/µl (P = 0.018) and duration of hospitalization (P = 0.027) between groups No significant difference in platelet recovery > 160,000/µl (P = 0.093) or survival 6-months (P = 0.79) between the two initial groups and between all dogs that did not receive hIVIG and those that did at some point during the 6-month period (P = 0.53) |
Putsche and Kohn [5] | LOE 3 Retrospective case series with a nested cohort study Small to very small number of dogs in each group Uncertain enrollment | 30 client-owned dogs with a diagnosis of primary ITP with a median initial platelet count of 8000/µL (0–111,000/µL) | Treatment during disease: Tx1: Prednisolone 1–1.5 mg/kg BID Tx2: Prednisolone 1–1.5 mg/kg BID + Vinc 0.02 mg/kg (Fq not described) Tx3: Prednisolone 1–1.5 mg/kg BID + Aza 1.5-2 mg/kg SID Tx4: Prednisolone 1–1.5 mg/kg BID + Cyclo 5 mg/kg SID C: Tx2 + Tx3 + Tx4 Adjunctive treatment at beginning of treatment or 5–43 days later, if no platelet recovery occurred or after a relapse | Platelet recovery ≥ 50,000/µL: Tx1: median 5 days (4–11 days) mean 6 ± 2.2 days SD Tx2: median 4 days (2–7 days) mean 4 ± 2 days SD Tx3: 4, 7 and 12 days Tx4: 5 and 9 days Adverse events: Tx3: Grade 5 death | No significant difference (P < 0.05) in relapse (P = 0.676) and mortality (P = 0.367) between Tx1 and C during 1684 days. Relapse: 26% [9%–51%] and Mortality: 10% [2%–27%] |
Huang et al. [27] | LOE 3 Retrospective (case- control study) Small to very small number of dogs in each group Uncertain enrollment | 48 client-owned dogs with a diagnosis of presumptive primary ITP, some had recent vaccination, with a median initial platelet count of 1000/µL (0–39,500/µL) | Treatment during hospitalization: Tx1: Prednisone 1-4 mg/kg/day or Dex 0.04–0.5 mg/kg/day + Aza 2 mg/kg/day Tx2: Prednisone 1-4 mg/kg/day or Dex 0.04–0.5 mg/kg/day + Vinc 0.02 mg/kg once Tx3: Prednisone 1-4 mg/kg/day or Dex 0.04–0.5 mg/kg/day + hIVIG 0.35–0.81 g/kg once | Platelet recovery = 40,000/µL: Tx1: median 6 days (4–12) Tx2: median 4 days (2–10) Tx3: median 5 days (2–10) Platelet recovery to reach reference range: Tx1: median 15 days (12–21) Tx2: median 10 days (3–42) Tx3: median 12 days (2–13) Survival to discharge: Tx1: 70% Tx2: 90% Tx3: 83% No evaluation of adverse events | No statistical evaluation of outcome |
Yau and Bianco [13] | LOE 3 Prospective case series Very small number of dogs in each group Uncertain enrollment | 5 client-owned dogs with a diagnosis of presumptive ITP, chronically treated NSAIDs for osteoarthritis with a median initial platelet count of 3000/µL (1000–14,000/µL) | Treatment during beginning of disease: Tx1: Mycophenolate mofetil 7.1–14.4 mg/kg BID, median 8.5 mg/kg | Platelet recovery > 50,000/µL: Tx1: median 3 days (2–6 days) Duration of hospitalization: Tx1: median 3 days (2-7 days) Platelet recovery ≥ 170,000/µL: Tx1: median 9 days (5–16 days) Survival to discharge: Tx1: 100% Adverse events: Tx1: Grade 2 moderate | No statistical evaluation of outcome |