Rapid platelet count improvement in chronic hepatitis C patients with thrombocytopenia receiving direct-acting antiviral agents

Lee

et al. 2021

BMC Gastroenterol

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Background Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear. Methods From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO. Results This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001). BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively. Conclusions BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.

Section: Discussioncontrasting

confidence: 99%

“…This was thought to be associated with an improved fibrosis stage and portal hypertension [4,5]. Reportedly, thrombocytopenia rapidly improves in CHC patients receiving direct-acting antiviral agents (DAA) [6][7][8][9][10]. However, this improvement, within short-term follow-up, is less likely due to changes in the fibrosis stage [11].…”

Section: Introductionmentioning

confidence: 99%

Baseline thrombopoietin level is associated with platelet count improvement in thrombocytopenic chronic hepatitis C patients after successful direct-acting antiviral agent therapy

Lee

et al. 2021

BMC Gastroenterol

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“…This was partly different from our previous study. 8 Our previous study showed that moderate to severe fatty liver and low BL platelet count could predict signi cant platelet count improvement. The most likely reasons were that some differences existed in the previous study, compared to ndings of the present study, including more case numbers (n = 249), more cancer patients (n = 19 vs. n = 0, P = 0.001), viable HCC patients (n = 14 vs. n = 0, P = 0.013), more advanced hepatic brosis patients (n = 213 vs. n = 72, P = 0.001), and more moderate to severe fatty liver patients (n = 24 vs. n = 5, P = 0.2).…”

Section: Discussionmentioning

confidence: 96%

“…4,5 Reportedly, thrombocytopenia rapidly improves in CHC patients receiving directacting antiviral agents (DAA). [6][7][8][9][10] However, this improvement, within short-term follow-up, is less likely due to changes in the brosis stage. 11 It suggests that factors other than brosis may play important roles, such as hypersplenism, thrombopoietic cytokines, antiplatelet antibody, or direct effect from hepatitis C virus (HCV) via suppressing hematopoiesis.…”

Section: Introductionmentioning

confidence: 99%

Baseline Thrombopoietin Level is Associated with Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients After Direct-Acting Antiviral Agent Therapy

Lee

et al. 2020

Preprint

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Background Thrombocytopenia can rapidly improve in chronic hepatitis C (CHC) patients receiving direct-acting antiviral agents (DAA). The role of baseline (BL) thrombopoietin (TPO) in this phenomenon is unclear. Methods From June 2016 to February 2019, a total of 104 CHC patients receiving DAA, with a sustained virologic response and BL thrombocytopenia, at Dalin Tzu Chi Hospital, were enrolled in this retrospective study. Significant platelet count improvement and platelet count improvement ratio were analyzed for correlation with BL TPO. Results This cohort included 40 men (38.5%). Seventy-two (69.2%) patients had advanced fibrosis. The platelet count [median (range)] increased from 110.5 (32–149) × 103/µL at BL to 116.5 (40–196) and 118.0 (35–275) × 103/µL at end of treatment (EOT) and 12 weeks after EOT (P12), respectively, (EOT vs. BL, P < 0.001; P12 vs. BL, P < 0.001).BL TPO was positively correlated with significant platelet count improvement (P < 0.001), platelet count improvement ratio at EOT (P = 0.004), and P12 (P < 0.001). The area under the receiver operating characteristic curve and optimal cutoffs (pg/ml) were 0.77 (95% confidence interval, 0.67–0.86) and 120, respectively, for significant platelet count improvement prediction. The sensitivity, specificity, and accuracy were 88.6%, 71.7%, and 78.8%, respectively. Conclusions BL TPO level might be a useful marker for predicting significant platelet count improvement in thrombocytopenic patients after successful DAA therapy.

“…IFN-free direct-acting antivirals (DAAs) have been the standard treatment for CHC [7][8][9][10]. Platelet count improvement has also been reported, and could be observed within a short-term follow-up period [11][12][13][14][15]. Liver fibrosis status is less likely to improve rapidly and significantly immediately after initiation of DAA therapy [16].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Significant Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients Receiving Direct-Acting Antivirals

Chang

et al. 2022

Viruses

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To clarify the predictive factors of significant platelet count improvement in thrombocytopenic chronic hepatitis C (CHC) patients. CHC patients with baseline platelet counts of <150 × 103/μL receiving direct-acting antiviral (DAA) therapy with at least 12-weeks post-treatment follow-up (PTW12) were enrolled. Significant platelet count improvement was defined as a ≥10% increase in platelet counts at PTW12 from baseline. Platelet count evolution at treatment week 4, end-of-treatment, PTW12, and PTW48 was evaluated. This study included 4922 patients. Sustained virologic response after 12 weeks post-treatment was achieved in 98.7% of patients. Platelet counts from baseline, treatment week 4, and end-of-treatment to PTW12 were 108.8 ± 30.2, 121.9 ± 41.1, 123.1 ± 43.0, and 121.1 ± 40.8 × 103/μL, respectively. Overall, 2230 patients (45.3%) showed significant platelet count improvement. Multivariable analysis revealed that age (odds ratio (OR) = 0.99, 95% confidence interval (CI): 0.99–1.00, p = 0.01), diabetes mellitus (DM) (OR = 1.20, 95% CI: 1.06–1.38, p = 0.007), cirrhosis (OR = 0.66, 95% CI: 0.58–0.75, p < 0.0001), baseline platelet counts (OR = 0.99, 95% CI: 0.98–0.99, p < 0.0001), and baseline total bilirubin level (OR = 0.80, 95% CI: 0.71–0.91, p = 0.0003) were independent predictive factors of significant platelet count improvement. Subgroup analyses showed that patients with significant platelet count improvement and sustained virologic responses, regardless of advanced fibrosis, had a significant increase in platelet counts from baseline to treatment week 4, end-of-treatment, PTW12, and PTW48. Young age, presence of DM, absence of cirrhosis, reduced baseline platelet counts, and reduced baseline total bilirubin levels were associated with significant platelet count improvement after DAA therapy in thrombocytopenic CHC patients.