Eltrombopag with i.v. immunoglobulin for safe splenectomy in refractory immune thrombocytopenia

Miyako, Kenichi; Onoda, Tadashi; Meguro, Tohru; Sato, Hiroko; Mitsui, Tetsuo

doi:10.1111/ped.13446

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…Several studies have employed in-situ hybridization techniques to demonstrate that the liver is the primary organ expressing mRNA of TPO, despite the expression of TPO mRNA in other organs[ 14 - 16 ]. It is now confirmed that the main site of TPO production in the body is the liver.…”

Section: Discussionmentioning

confidence: 99%

Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism

Liu,

Zhang,

Cui

et al. 2023

World J Gastrointest Surg

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Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.

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Section: Discussionmentioning

confidence: 99%

Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism

Liu,

Zhang,

Cui

et al. 2023

World J Gastrointest Surg

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“…It was suggested that efforts should be made to increase the platelet count to >20 × 10 9 /L before surgery for patients to undergo LS safely [28]. Various measures are available to increase the platelet count, at least temporarily, before splenectomy, e.g., administering immunosuppressants, intravenous immunoglobulins, steroids (usually a higher dose), or TPO-RAs [4, 33, 34]. Alternatively, the platelet count can be increased by transfusion of platelet concentrates [35].…”

Section: Discussionmentioning

confidence: 99%

Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

et al. 2020

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Introduction: Splenectomy is an important and potentially curative treatment for immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has replaced open splenectomy (OS) as the standard approach. The prognostic role of platelet count and the clinical indication of preoperative platelet transfusion are not entirely clear. Methods: We designed a study to explore the prognostic impact of surgical methods, platelet count, and platelet transfusion in a large, single-institute, long-term cohort of ITP patients. Result: In 118 ITP patients, there was no difference between OS and LS in response and surgical complications. The overall response rate was 77% and the complete response (CR) rate was 70%. Patients with a CR had a trend towards a higher baseline platelet count. A stable platelet count 14-28 days after splenectomy was associated with a sustained long-term response. Patients requiring preoperative platelet transfusion had a lower preoperative platelet count and were more likely to need postoperative transfusion of red blood cells and platelets. They also had a lower postoperative platelet count than the nontransfusion group. Relapse-free survival did not differ. Conclusions: Baseline and postoperative platelet counts are apparently associated with the treatment response to splenectomy but the difference did not reach statistical significance. Preoperative platelet transfusion did not overcome the disadvantage of thrombocytopenia and was not recommended when other preparative measures are available.

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“…5,6 Eltrombopag selectively unites to the transmembrane region of the TPO receptor and triggers megakaryocytopoiesis through the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway. 7 While no clinical trials focus on the efficacy or safety of these drugs in patients with secondary ITP relevant to SS, limited case reports and case series have displayed promising results in patients with SLE or APS secondary ITP, [8][9][10] which occurred via similar pathogenesis. Hence, more data are required to inform clinicians whether patients with SS benefit from Eltrombopag.…”

Section: Introductionmentioning

confidence: 99%

“…While no clinical trials focus on the efficacy or safety of these drugs in patients with secondary ITP relevant to SS, limited case reports and case series have displayed promising results in patients with SLE or APS secondary ITP, 8 – 10 which occurred via similar pathogenesis. Hence, more data are required to inform clinicians whether patients with SS benefit from Eltrombopag.…”

Section: Introductionmentioning

confidence: 99%

Eltrombopag improves refractory thrombocytopenia in patients with Sjögren's syndrome

Zhang

Lin

et al. 2022

Science Progress

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Introduction: Eltrombopag, a kind of thrombopoietin (TPO) receptor agonist, plays the role on the megakaryocyte to activate the platelet production and rapidly increase the number of circulating platelets in patients with primary immune thrombocytopenia (ITP). Eltrombopag provides an opportunity for rapid tapering and/or cessation of corticosteroid therapy. However, it is not clear about the platelet response to Eltrombopag in ITP associated with Sjögren's Syndrome(SS). Methods: A retrospective research was conducted on the clinical course of three patients, each with ITP secondary to SS, and initially received therapy of corticosteroids or other immunomodulatory. They took this drug for bleeding diseases. Referring to the description, Eltrombopag was prescribed and adjusted with an initial dose of 25 mg daily, then weekly, then monthly according to the monitoring of platelet counts. Results: All patients maintained a satisfactory level of platelet counts (>100,000/mm3 for >2 years) following corticosteroid withdrawal. Meanwhile, Eltrombopag was well-tolerated, and there were no adverse effects, such as thrombotic events. Conclusions: Eltrombopag is effective and safe for patients with ITP associated with SS during corticosteroid withdrawal. Thus it may be a crucial therapeutic strategy for reducing corticosteroid-related side effects in SS patients with ITP.

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Eltrombopag with i.v. immunoglobulin for safe splenectomy in refractory immune thrombocytopenia

Cited by 5 publications

References 4 publications

Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism

Effects of thrombopoietin pre-treatment on peri-liver transplantation thrombocytopenia in a mouse model of cirrhosis with hypersplenism

Impact of Platelet Counts, Surgical Methods, and Preoperative Platelet Transfusion on the Outcome of Splenectomy for Immune Thrombocytopenia

Eltrombopag improves refractory thrombocytopenia in patients with Sjögren's syndrome

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