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of chronic liver disease (CLD)-related severe thrombocytopenia (TCP) recently published in Frontiers in Pharmacology.
At the same time, we also invited Professor Liu Lianxin from the First Affiliated Hospital of the University of Science and Technology of China to introduce the clinical background
of the team's research to us.
The following is the full video of Professor Liu Lianxin and Professor Wang Jizhou interpreting the literature:
Prognosis of patients with chronic liver disease-related thrombocytopenia
Chronic liver disease (CLD) is a significant and underestimated public health burden
associated with high mortality.
Worldwide, 844 million people suffer from chronic liver disease, with a mortality rate
of up to 2 million per year.
The progression of chronic liver disease to liver fibrosis, end-stage cirrhosis, liver failure, and hepatocellular carcinoma is closely related
to increased patient morbidity, frequency of hospitalization, and deterioration of quality of life.
Thrombocytopenia (TCP), the most common complication of chronic liver disease, affects up to 76% of patients with
advanced liver fibrosis or cirrhosis.
Decreased production of thrombopoietin (TPO) by the liver and direct bone marrow suppression are the main mechanisms
.
In addition, as liver disease progresses, patients often require more frequent invasive procedures such as endoscopic biopsy, percutaneous biopsy, surgical radiofrequency ablation, or hepatectomy
.
Many patients, especially those with chronic liver disease with severe thrombocytopenia (TCP), have low platelet counts that prevent them from undergoing the necessary surgery to improve survival or improve their quality of life
.
Current status of drug treatment for thrombocytopenia associated with chronic liver disease
For these patients undergoing invasive procedures, platelet transfusions are often used
clinically.
However, the use of platelet transfusions may be limited
by the production of antiplatelet antibodies, high cost, short shelf life, risk of infection, and other transfusion-related complications.
Recombinant human thrombopoietin (rhTPO) Although some clinically centers still use rh-TPO to treat CLD combined with TCP, rhTPO has no indication for CLD-related thrombocytopenia in China; As a novel oral TPO-RA, avartrombopag has been approved as an alternative to platelet transfusion in adult patients
with chronic liver disease-associated thrombocytopenia undergoing elective diagnostic procedures or surgery.
The theme of this issue of "Shin Express"
This issue is a retrospective study that is the world's first real-world clinical study
comparing the efficacy and safety of oral avatrombopag and subcutaneous rh-TPO.
The study retrospectively analyzed the clinical data
of 237 patients with severe TCP associated with chronic liver disease admitted to the First Affiliated Hospital of University of Science and Technology of China from January 2019 to January 2022.
The clinical efficacy
of arvarotrombopag and recombinant human thrombopoietin in the treatment of severe thrombocytopenia associated with chronic liver disease was compared using statistical analysis methods for propensity score matching.
The results show:
1.
Atvartrombopag is significantly more effective than rh-TPO in the treatment of Child-Pugh Class A CLD-related TCP, and the incidence of dizziness is lower
.
2.
Whether it is oral form of avarambopag or subcutaneous injection form of rh-TPO, the efficacy in the treatment of PLTs > 25×10 9/L is higher
than that of PLTs < 25×109/L.