Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Japan.
Intern Med. 2021 Mar 15;60(6):829-837. doi: 10.2169/internalmedicine.5930-20. Epub 2020 Oct 21.
Objective Lusutrombopag is a thrombopoietin receptor agonist that improves thrombocytopenia in patients with chronic liver disease scheduled to undergo invasive procedures. However, information on the efficacy of repeated lusutrombopag treatment and factors associated with the treatment is scarce. We analyzed the efficacy of repeated lusutrombopag treatment and the factors associated with a response to lusutrombopag. Methods Thirty-nine patients with chronic liver disease who received lusutrombopag treatment before undergoing invasive procedures were enrolled in this retrospective study. Of the 39 patients, 10 received lusutrombopag treatment multiple times for a total of 53 regimens of lusutrombopag treatment. Changes in platelet counts, the effects of repeated lusutrombopag treatment, and factors associated with response to lusutrombopag were analyzed. Results The median platelet count increased significantly from 4.5×10/μL before lusutrombopag treatment to 7.2×10/μL before the invasive procedure (p<0.01), and patients undergoing 49 of the 53 (92%) treatment regimens succeeded in undergoing invasive procedures without needing platelet transfusions. In patients who received lusutrombopag treatment repeatedly, the median platelet count significantly increased following the second administration of lusutrombopag, and the effects of lusutrombopag were similar between the first and second administration. A multivariate analysis identified the absence of diabetes mellitus (odds ratio, 5.56 for presence; p=0.04) as a significant and independent predictor of a response to lusutrombopag. Conclusion Lusutrombopag treatment significantly increased platelet counts in patients with chronic liver disease, making it possible to receive invasive procedures. The treatment produced identical effects when it was repeated. The efficacy of lusutrombopag might be decreased in patients with diabetes mellitus.
芦曲泊帕是一种促血小板生成素受体激动剂，可改善计划接受有创操作的慢性肝病患者的血小板减少症。然而，关于芦曲泊帕重复治疗的疗效和与治疗相关的因素的信息很少。我们分析了重复芦曲泊帕治疗的疗效和与芦曲泊帕反应相关的因素。
本回顾性研究纳入了 39 例在接受有创操作前接受芦曲泊帕治疗的慢性肝病患者。这 39 例患者中，有 10 例患者因治疗需要接受了多次芦曲泊帕治疗，共进行了 53 个芦曲泊帕治疗疗程。分析了血小板计数的变化、重复芦曲泊帕治疗的效果以及与芦曲泊帕反应相关的因素。
血小板计数中位数从芦曲泊帕治疗前的 4.5×10/μL 显著增加到有创操作前的 7.2×10/μL（p<0.01），53 个治疗疗程中的 49 个（92%）成功地使患者无需血小板输注即可接受有创操作。在重复接受芦曲泊帕治疗的患者中，第二次芦曲泊帕给药后血小板计数中位数显著增加，且第一次和第二次芦曲泊帕给药的效果相似。多变量分析发现，无糖尿病（存在的优势比为 5.56；p=0.04）是对芦曲泊帕反应的一个显著和独立的预测因素。
芦曲泊帕治疗可显著增加慢性肝病患者的血小板计数，使其能够接受有创操作。重复治疗产生相同的效果。芦曲泊帕的疗效可能在患有糖尿病的患者中降低。
