Use of eltrombopag in thrombocytopenia of liver disease

Abstract

Second generation thrombopoietin agonists including eltrombopag and romiplostim act on the thrombopoietin receptor to increase the megakaryocyte production. These agents were needed as use of first generation recombinant products was associated with formation of autoantibodies. Eltrombopag is an oral thrombopoietin agonist found effective in raising platelet counts in patients with immune thrombocytopenia. The drug has now been found to be useful in raising platelet counts in thrombocytopenia related to liver disease including cirrhosis and chronic viral hepatitis. Although the drug may help enable adequate interferon therapy in patients with HCV infection and help carry out invasive procedures in patients with cirrhosis, concerns have been raised of possible thrombotic complications including portal vein thrombosis. Randomized trials have shown that use of eltrombopag concomitant with pegylated interferon and ribavirin increased the chances of sustained virologic response while decreasing the dose reductions of interferon. The data on use of romiplostim in these clinical indications is also emerging. However, in the future, availability of interferon free regimens is likely to decrease the use of eltrombopag for enabling antiviral therapy. The review discusses the role of eltrombopag in management of liver disease related thrombocytopenia in wake of recent data as also the dosage, precautions and adverse effects associated with its use.

Keywords: Cirrhosis; Thrombopoietin; Eltrombopag; Romiplostim; Hepatitis; Hepatitis C virus; Splenectomy; Thrombocytopenia

Core tip: Thrombocytopenia associated with liver disease is multifactorial. Eltrombopag, a thrombopoietin agonist, has been found useful in increasing platelet counts in these patients. It has been clinically used to increase platelet counts in cirrhotic patients prior to invasive procedures and in patients with chronic hepatitis C to enable administration of interferon based antiviral therapy. However, there are concerns regarding its safety and possible increased risk of portal vein thrombosis.