Effects of Lusutrombopag on Post-invasive Procedural Bleeding in Thrombocytopenic Patients with Chronic Liver Disease.
Hemorrhage
Length of stay
Liver cirrhosis
Medical costs
Platelet transfusion
Radiofrequency ablation
Real world data
Rescue for bleeding
Thrombocytopenia
Thrombopoietin receptor agonist
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
06
09
2021
accepted:
15
10
2021
pubmed:
9
11
2021
medline:
9
3
2022
entrez:
8
11
2021
Statut:
ppublish
Résumé
Thrombocytopenia can increase the bleeding risk in patients with chronic liver disease (CLD) undergoing invasive procedures. Prophylactic platelet transfusion (PT) is often performed to increase platelet counts in patients with CLD undergoing invasive procedures to prevent bleeding. Lusutrombopag, a small-molecule thrombopoietin receptor agonist, is expected to be an alternative therapy to prophylactic PT. This study aimed to compare the effects between lusutrombopag and PT. Data were obtained from a Japanese administrative database (April 2008-May 2019). Patients aged ≥ 18 years who underwent planned invasive procedures after the first CLD diagnosis and were observed for ≥ 30 days prior to invasive procedures were considered eligible. Patients who underwent planned invasive procedures with lusutrombopag prescription at 5-30 days before the procedure were categorized as the lusutrombopag group, whereas those who received PT at 1 day before and/or on the same day as the procedure, without lusutrombopag prescription, were classified as the PT group. Outcomes, including bleeding frequency during hospitalization and average medical costs (costs for prophylactic treatment and total costs between the day of the invasive procedure and 30 days after the invasive procedure), were compared between the groups after matching. Among 738,878 patients with CLD, 379 cases for each group were identified after matching. The incidence of bleeding events was lower in the lusutrombopag group than in the PT group (3.7% vs. 8.2%, p < 0.001). Average medical costs were lower in the lusutrombopag group than in the PT group ($6667 as of August 2021 vs. $7170, p = 0.011). Lusutrombopag is suggested to be effective as a prophylactic treatment for bleeding prevention in patients with CLD undergoing planned invasive procedures.
Identifiants
pubmed: 34748184
doi: 10.1007/s12325-021-01965-7
pii: 10.1007/s12325-021-01965-7
pmc: PMC8799534
doi:
Substances chimiques
Cinnamates
0
Receptors, Thrombopoietin
0
Thiazoles
0
lusutrombopag
6LL5JFU42F
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
379-390Informations de copyright
© 2021. The Author(s).
Références
Afdhal N, McHutchison J, Brown R, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008;48(6):1000–7.
doi: 10.1016/j.jhep.2008.03.009
Peck-Radosavljevic M. Thrombocytopenia in chronic liver disease. Liver Int. 2017;37(6):778–93.
doi: 10.1111/liv.13317
Hayashi H, Beppu T, Shirabe K, Maehara Y, Baba H. Management of thrombocytopenia due to liver cirrhosis: a review. World J Gastroenterol. 2014;20(10):2595–605.
doi: 10.3748/wjg.v20.i10.2595
Takami A, Matsushita T, Ogata M, et al. Guideline for the use of platelet transfusion concentrates based on scientific evidence: update 2019. Jpn J Transfus Cell Ther. 2019;65(3):544–61.
doi: 10.3925/jjtc.65.544
Hidaka H, Kurosaki M, Tanaka H, et al. Lusutrombopag reduces need for platelet transfusion in patients with thrombocytopenia undergoing invasive procedures. Clin Gastroenterol Hepatol. 2019;17(6):1192–200.
doi: 10.1016/j.cgh.2018.11.047
Brown RS, Bentley R, Cai B, et al. The clinical and economic burden of patients with chronic liver disease and thrombocytopaenia receiving platelet transfusions during planned invasive procedures. GastroHep. 2019;1(5):236–48.
doi: 10.1002/ygh2.357
Tateishi R, Seike M, Kudo M, et al. A randomized controlled trial of lusutrombopag in Japanese patients with chronic liver disease undergoing radiofrequency ablation. J Gastroenterol. 2019;54(2):171–81.
doi: 10.1007/s00535-018-1499-2
Mulpleta Tablets 3mg [Package Insert]. Shionogi & Co., Ltd. December, 2015. https://www.info.pmda.go.jp/go/pdf/340018_3399010F1022_1_03 . Accessed 27 Jan 2021. (Japanese).
Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2020. Hepatol Res. 2021;51(7):725–49.
doi: 10.1111/hepr.13678
Peck-Radosavljevic M, Simon K, Iacobellis A, et al. Lusutrombopag for the treatment of thrombocytopenia in patients with chronic liver disease undergoing invasive procedures (L-PLUS 2). Hepatology. 2019;70(4):1336–48.
doi: 10.1002/hep.30561
Furuichi Y, Takeuchi H, Yoshimasu Y, Kasai Y, Abe M, Itoi T. Thrombopoietin receptor agonist is more effective than platelet transfusion for chronic liver disease with thrombocytopenia, shown by propensity score matching. Hepatol Res. 2020;50(9):1062–70.
doi: 10.1111/hepr.13530
About MDV Database: Medical Data Vision Co., Ltd. https://en.mdv.co.jp/about-mdv-database/ . Accessed 4 Aug 2020.
Anatomical Classification: The European Pharmaceutical Market Research Association. https://www.ephmra.org/classification/anatomical-classification/ . Accessed 4 Aug 2020.
Statistical classification of diseases and cause of death 2013: Ministry of Health, Labour and Welfare. http://www.mhlw.go.jp/toukei/sippei/ . Accessed 4 Aug 2020.
Instruction manual of project to promote studies on liver cancer and severe cirrhosis treatment (for medical institution): document collection 2021: Ministry of Health, Labor and Welfare. https://www.mhlw.go.jp/content/10900000/000763068.pdf . Accessed 30 July 2021. (Japanese).
Sasaki R, Shiino C, Imawari M, et al. Safety and effectiveness of lusutrombopag in Japanese chronic liver disease patients with thrombocytopenia undergoing invasive procedures: interim results of a postmarketing surveillance. Hepatol Res. 2019;49(10):1169–81.
doi: 10.1111/hepr.13392