Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2018; 24(46): 5271-5279
Published online Dec 14, 2018. doi: 10.3748/wjg.v24.i46.5271
Relationship between response to lusutrombopag and splenic volume
Haruki Uojima, Yoshitaka Arase, Norio Itokawa, Masanori Atsukawa, Takashi Satoh, Koji Miyazaki, Hisashi Hidaka, Ji Hyun Sung, Makoto Kako, Kota Tsuruya, Tatehiro Kagawa, Katsuhiko Iwakiri, Ryouichi Horie, Wasaburo Koizumi
Haruki Uojima, Ji Hyun Sung, Makoto Kako, Department of Gastroenterology, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
Haruki Uojima, Hisashi Hidaka, Wasaburo Koizumi, Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
Yoshitaka Arase, Kota Tsuruya, Tatehiro Kagawa, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa 259-1193, Japan
Norio Itokawa, Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba 270-1694, Japan
Masanori Atsukawa, Katsuhiko Iwakiri, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo 113-8603, Japan
Takashi Satoh, Ryouichi Horie, Division of Hematology, Department of Medical Laboratory Sciences, Kitasato University School of Allied Health Sciences, Kanagawa 252-0375, Japan
Takashi Satoh, Ryouichi Horie, Division of Molecular Hematology, Kitasato University Graduate School of Medical Sciences, Kanagawa 252-0375, Japan
Koji Miyazaki, Department of Transfusion and Cell Transplantation, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
Author contributions: Uojima H, Arase Y, Itokawa N, Atsukawa M, Satoh T, Miyazaki K, Hidaka H, Sung JH, Kako M, Tsuruya K, Kagawa T, Iwakiri K, Horie R, and Koizumi W contributed equally to this work; Uojima H, Arase Y, and Itokawa N collected and analyzed the data; Uojima H drafted the manuscript; Hidaka H designed and supervised the study; Atsukawa M, Satoh T, Miyazaki K, Kako M, Tsuruya K, Kagawa T, Iwakiri K, Horie R, and Koizumi W offered technical or material support; all authors discussed the results and commented on the manuscript.
Institutional review board statement: The study was reviewed and approved by the Tokushukai Group Ethical Committee’s institutional review board.
Informed consent statement: This study is a retrospective observational study. Informed consent was obtained from all individual participants included in the study by the opt-out method of our hospital website.
Conflict-of-interest statement: We declare no conflicts of interest.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author (email: kiruha@kitasato-u.ac.jp).
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Haruki Uojima, MD, PhD, Doctor, Department of Gastroenterology, Shonankamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan. kiruha@kitasato-u.ac.jp
Telephone: +81-467-461717 Fax: +81-467-450190
Received: September 12, 2018
Peer-review started: September 12, 2018
First decision: October 14, 2018
Revised: October 20, 2018
Accepted: November 9, 2018
Article in press: November 9, 2018
Published online: December 14, 2018
Abstract
AIM

To assess the correlation between the efficacy of lusutrombopag and clinical characteristics in patients with chronic liver disease.

METHODS

In this retrospective, multicenter study, which conducted at four locations in Japan, 50 thrombocytopenic patients with chronic liver disease were enrolled. All patients received oral lusutrombopag (3.0 mg/d for 7 d) for chronic liver disease. We assessed the increase in platelet count after the trial drug administration. A treatment response was defined as a platelet count ≥ 5 × 104/μL and an increased platelet count ≥ 2 × 104/μL from baseline after drug administration. We evaluated the response to lusutrombopag compared to baseline clinical characteristics in patients with chronic liver disease.

RESULTS

The numbers of responders and non-responders were 40 (80.0%) and 10 (20.0%), respectively. The patients were divided into a responder and non-responder group, and we added factors that may correspond to successful treatment with lusutrombopag. Splenic volume and body weight were lower in the responder group than in the non-responder group. White blood cell count and hemoglobin level were higher in responders compared with non-responders. Using a logistic regression model to assess the relationship between response to lusutrombopag and clinical characteristics, multivariate analysis confirmed that splenic volume was an independent factor that predicted the response of platelet counts (P = 0.025; odds ratio = 11.2; 95% confidence interval: 1.354-103.0). Splenic volume negatively correlated to changes in platelet count (r = -0.524, P = 0.001).

CONCLUSION

Splenic volume influences the change in platelet counts after administration of lusutrombopag in patients with chronic liver disease.

Keywords: Lusutrombopag, Portal hypertension, Splenic volume, Thrombocytopenia, Thrombopoietin receptor agonist

Core tip: Lusutrombopag is an oral, small-molecule thrombopoietin receptor agonist used for the treatment of thrombocytopenic patients with chronic liver diseases. However, the response to this drug is unpredictable. The study aimed to assess the correlation between the clinical characteristics of patients with chronic liver disease and the efficacy of lusutrombopag treatment. Splenic volume influences the change in platelet counts after administration of lusutrombopag in patients with chronic liver disease. Splenic volume increase is negatively related to changes in the platelet count.