Eltrombopag in chronic hepatitis C

Abstract

Chronic hepatitis C is a public health problem worldwide. Unfortunately, not all patients may benefit from antiviral therapy due to thrombocytopenia. Its causes are represented by portal hypertension and platelet sequestration in the spleen, decreased serum levels or activity of thrombopoietin, the bone marrow suppression induced by hepatitis C virus and a possible adverse effect of interferon. Thrombopoietin receptor analogs may contribute to increase platelet counts in these patients. Eltrombopag binds to another region of the thrombopoietin receptor compared to endogenous thrombopoietin and stimulates the proliferation and maturation of megakaryocytes and the platelet production in a dose-dependent manner. Eltrombopag has proven its effectiveness for the treatment of patients with primary immune thrombocytopenia. Its indication for other hemopathies or situations (like thrombocytopenia secondary to chemo- or radiotherapy, acute leukemia, myelodysplastic syndroms, acquired and hereditary bone marrow failure, and platelet donors) is under study. Eltrombopag may be particularly useful in patients with advanced chronic hepatitis or liver cirrhosis who require antiviral treatment. We present a minireview on the results of treatment with eltrombopag in patients chronically infected with hepatitis C virus, highlighting the benefits and mentioning possible adverse effects. In some studies eltrombopag increased the number of virological responses after clasical antiviral treatment of patients with chronic hepatitis C and reduced the transfusional requirements of those who had to be subjected to invasive surgery. Eltrombopag is a solution for many of these patients, which allows them receiving antiviral therapy and sometimes getting a sustained virological response, but they must be well monitored to prevent possible thromboembolic or bone marrow complications or liver failure occurrence.

Effects of Helicobacter pylori Eradication on the Platelet Count in Hepatitis C Virus-Infected Patients

“…Recently, oral thrombopoietin receptor agonists such as eltrombopag [14-16] and lusutrombopag [17] have been developed as agents to increase the platelet count. These new drugs reduce the bleeding risk without platelet transfusion under the invasive treatment and have also been reported to be clinically useful.…”

“…However, eltrombopag administration may be associated with an increased risk of thromboembolic events in cirrhotic patients, although the precise mechanisms of this event have not been clarified. Therefore, thrombopoietin receptor agonists should be administered only following a careful evaluation of the risks and benefits [14-16]. Since H. pylori infection significantly increases the risk of gastric cancer, the Japanese guidelines recommend that all H. pylori -infected patients receive anti- H. pylori therapy [9].…”

Sustained Virological Response After Six Weeks Treatment with a Sofosbuvir-Containing Regimen in a Patient Infected with Hepatitis C Virus Genotype 4: A Case Report

“…The patients with liver cirrhosis produced by hepatitis C virus have thrombocytopenia. Eltrombopag increases the platelet count and allows the initiation of therapy with pegylated interferon and ribavirin and, in a significant proportion of patients, completes the proposed therapy for 12 weeks (11). This patient was taking eltrombopag that could have contributed to the low albumin level through an unknown interaction or reaction to the drug.…”

“…Eltrombopag binds to thrombopoietin receptor and stimulates the proliferation and maturation of megakaryocytes and hence platelet production in a dose-dependent manner (11). The patients with liver cirrhosis produced by hepatitis C virus have thrombocytopenia.…”

Danazol one Month Treatment of Thrombocytopenia in Chronic Hepatitis C

“…The use of Eltrombopag in HCV patients with thrombocytopenia is cost-effective [14]. Eltrombopag increased safely platelet levels in dose dependent manner in HCV related compensated liver diseases with thrombocytopenia over 4 weeks of therapy [15,16] but, although this patient must be well monitored to prevent possible thromboembolic or bone marrow complications or liver failure occurrence [17]. …”