Avatrombopag in the treatment of thrombocytopenia in adults with chronic liver disease scheduled to undergo a procedure: a profile of its use in the USA
Tóm tắt
Avatrombopag (Doptelet®) is the first thrombopoietin receptor agonist approved in the USA to treat thrombocytopenia in adults with chronic liver disease who are scheduled to undergo a procedure. It is an important new development to mitigate the risk of bleeding and improve post-procedure management in this patient population. Relative to placebo, oral avatrombopag significantly increased the proportion of patients who did not require a platelet transfusion or rescue procedure up to 7 days after the scheduled procedure. Its efficacy was not altered by the bleeding risk associated with the procedure, or by patient age, sex, race, or degree of hepatic impairment. Avatrombopag has a convenient 5-day oral administration regimen and is well tolerated.
Tài liệu tham khảo
National Heart, Lung, and Blood Institute. Thrombocytopenia. Bethesda (MD): National Heart, Lung, and Blood Institute; 2018.
Mitchell O, Feldman DM, Diakow M, et al. The pathophysiology of thrombocytopenia in chronic liver disease. Hepat Med. 2016;8:39–50.
Kuter DJ. The biology of thrombopoietin and thrombopoietin receptor agonists. Int J Hematol. 2013;98(1):10–23.
Afdhal N, McHutchison J, Brown R, et al. Thrombocytopenia associated with chronic liver disease. J Hepatol. 2008;48(6):1000–7.
Giannini EG, Greco A, Marenco S, et al. Incidence of bleeding following invasive procedures in patients with thrombocytopenia and advanced liver disease. Clin Gastroenterol Hepatol. 2010;8(10):899–902.
Seeff LB, Everson GT, Morgan TR, et al. Complication rate of percutaneous liver biopsies among persons with advanced chronic liver disease in the HALT-C trial. Clin Gastroenterol Hepatol. 2010;8(10):877–83.
Poordad F. Review article: thrombocytopenia in chronic liver disease. Aliment Pharmacol Ther. 2007;26(Suppl 1):5–11.
Nplate® (romiplostim) for injection, for subcutaneous use: US prescribing information. Thousand Oaks (CA): Amgen, Inc.; 2017.
Promacta® (eltrombopag) tablets: US prescribing information. East Hanover (NJ): Novartis Pharmaceuticals Corporation; 2018.
Afdhal NH, Giannini EG, Tayyab G, et al. Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. N Engl J Med. 2012;367(8):716–24.
Doptelet® (avatrombopag) tablets: US prescribing information. Durham (NC): Dova Pharmaceuticals; 2018.
Fukushima-Shintani M, Suzuki K, Iwatsuki Y, et al. AKR-501 (YM477) a novel orally-active thrombopoietin receptor agonist. Eur J Haematol. 2009;82(4):247–54.
Fukushima-Shintani M, Suzuki K, Iwatsuki Y, et al. AKR-501 (YM477) in combination with thrombopoietin enhances human megakaryocytopoiesis. Exp Hematol. 2008;36(10):1337–42.
Terrault N, Chen Y-C, Izumi N, et al. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018;155(3):705–18.
Michelson AD, Smolensky Koganov E, Forde EE, et al. Avatrombopag increases platelet count but not platelet activation in patients with thrombocytopenia resulting from liver disease. J Thromb Haemost. 2018;16:1–5.