Efficacy of Lusutrombopag for Thrombocytopenia in Patients with Chronic Liver Disease Scheduled to Undergo Invasive Procedures

Yuno Nishida; Tomokazu Kawaoka; Michio Imamura; Maiko Namba; Yasutoshi Fujii; Shinsuke Uchikawa; Kazuki Ohya; Kana Daijo; Yuji Teraoka; Kei Morio; Hatsue Fujino; Takashi Nakahara; Masami Yamauchi; Akira Hiramatsu; Masataka Tsuge; Hiroshi Aikata; Shoichi Takahashi; C. Nelson Hayes; Takayuki Fukuhara; Keiji Tsuji; Keiko Arataki; Yuko Nagaoki; Yasuyuki Aisaka; Koji Kamada; Hideaki Kodama; Kazuaki Chayama

doi:10.2169/internalmedicine.5930-20

ORIGINAL ARTICLE

Efficacy of Lusutrombopag for Thrombocytopenia in Patients with Chronic Liver Disease Scheduled to Undergo Invasive Procedures

Yuno Nishida, Tomokazu Kawaoka, Michio Imamura, Maiko Namba, Yasutoshi Fujii, Shinsuke Uchikawa, Kazuki Ohya, Kana Daijo, Yuji Teraoka, Kei Morio, Hatsue Fujino, Takashi Nakahara, Masami Yamauchi, Akira Hiramatsu, Masataka Tsuge, Hiroshi Aikata, Shoichi Takahashi, C. Nelson Hayes, Takayuki Fukuhara, Keiji Tsuji, Keiko Arataki, Yuko Nagaoki, Yasuyuki Aisaka, Koji Kamada, Hideaki Kodama, Kazuaki Chayama

Author information

Yuno Nishida
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Tomokazu Kawaoka
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Michio Imamura
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Maiko Namba
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Yasutoshi Fujii
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Shinsuke Uchikawa
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Kazuki Ohya
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Kana Daijo
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Yuji Teraoka
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Kei Morio
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Hatsue Fujino
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Takashi Nakahara
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Masami Yamauchi
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Akira Hiramatsu
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Masataka Tsuge
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Hiroshi Aikata
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Shoichi Takahashi
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
C. Nelson Hayes
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
Takayuki Fukuhara
Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Japan
Keiji Tsuji
Department of Gastroenterology/Liver Center, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Japan
Keiko Arataki
Department of Gastroenterology, Tsuchiya General Hospital, Japan
Yuko Nagaoki
Department of Gastroenterology, Mazda Hospital, Japan
Yasuyuki Aisaka
Department of Gastroenterology, JA Hiroshima General Hospital, Japan
Koji Kamada
Department of Internal Medicine, Shobara Red Cross Hospital, Japan
Hideaki Kodama
Department of Hepatology, Hiroshima-Nishi Medical Center, Japan
Kazuaki Chayama
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan

Keywords: lusutrombopag, thrombocytopenia, thrombopoietin receptor agonist, chronic liver disease, diabetes mellitus

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 6 Pages 829-837

DOI https://doi.org/10.2169/internalmedicine.5930-20

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Details

Abstract

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 4.5×10⁴/μL before lusutrombopag treatment to 7.2×10⁴/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.

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