Difference between revisions of "Thrombocytopenia in liver disease"
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Warner-admin (talk | contribs) m (Text replacement - "https://www.gastrojournal.org/article/S0016-5085(18)34545-1" to "https://doi.org/10.1053/j.gastro.2018.05.025") |
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=Thrombocytopenia in liver disease with planned procedure= | =Thrombocytopenia in liver disease with planned procedure= | ||
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==Avatrombopag monotherapy {{#subobject:7c8c62|Regimen=1}}== | ==Avatrombopag monotherapy {{#subobject:7c8c62|Regimen=1}}== | ||
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===Regimen {{#subobject:666055|Variant=1}}=== | ===Regimen {{#subobject:666055|Variant=1}}=== | ||
{| class="wikitable" style="color:white; background-color:#404040" | {| class="wikitable" style="color:white; background-color:#404040" | ||
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====Growth factor therapy==== | ====Growth factor therapy==== | ||
*[[Avatrombopag (Doptelet)]] by the following laboratory-based criteria: | *[[Avatrombopag (Doptelet)]] by the following laboratory-based criteria: | ||
**Platelet count less than 40 x 10<sup>9</sup>/L: 60 mg PO once per day on days 1 to 5 | **Platelet count less than 40 x 10<sup>9</sup>/L: 60 mg PO once per day on days 1 to 5 | ||
**Platelet count at least 40 and less than 50 x 10<sup>9</sup>/L: 40 mg PO once per day on days 1 to 5 | **Platelet count at least 40 and less than 50 x 10<sup>9</sup>/L: 40 mg PO once per day on days 1 to 5 | ||
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'''Procedure days were days 10 to 13''' | '''Procedure days were days 10 to 13''' | ||
| − | + | </div></div> | |
===References=== | ===References=== | ||
# '''ADAPT-1:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01972529 | # '''ADAPT-1:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01972529 | ||
# '''ADAPT-2:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01976104 | # '''ADAPT-2:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01976104 | ||
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==Lusutrombopag monotherapy {{#subobject:8f4acd|Regimen=1}}== | ==Lusutrombopag monotherapy {{#subobject:8f4acd|Regimen=1}}== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen {{#subobject:4c9447|Variant=1}}=== | ===Regimen {{#subobject:4c9447|Variant=1}}=== | ||
{| class="wikitable" style="color:white; background-color:#404040" | {| class="wikitable" style="color:white; background-color:#404040" | ||
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|- | |- | ||
|} | |} | ||
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====Growth factor therapy==== | ====Growth factor therapy==== | ||
*[[Lusutrombopag (Mulpleta)]] 3 mg PO once per day on days 1 to 7 | *[[Lusutrombopag (Mulpleta)]] 3 mg PO once per day on days 1 to 7 | ||
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'''7-day course''' | '''7-day course''' | ||
| + | </div></div> | ||
===References=== | ===References=== | ||
# '''L-PLUS 1:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] JapicCTI-132323 | # '''L-PLUS 1:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] JapicCTI-132323 | ||
# '''L-PLUS 2:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] NCT02389621 | # '''L-PLUS 2:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] NCT02389621 | ||
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==Placebo== | ==Placebo== | ||
| − | + | <div class="toccolours" style="background-color:#eeeeee"> | |
===Regimen=== | ===Regimen=== | ||
{| class="wikitable sortable" style="width: 100%; text-align:center;" | {| class="wikitable sortable" style="width: 100%; text-align:center;" | ||
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|} | |} | ||
''No active treatment.'' | ''No active treatment.'' | ||
| + | </div></div> | ||
===References=== | ===References=== | ||
# '''ADAPT-1:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01972529 | # '''ADAPT-1:''' Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. [https://doi.org/10.1053/j.gastro.2018.05.025 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29778606 PubMed] NCT01972529 | ||
| Line 127: | Line 126: | ||
# '''L-PLUS 1:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] JapicCTI-132323 | # '''L-PLUS 1:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] JapicCTI-132323 | ||
# '''L-PLUS 2:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] NCT02389621 | # '''L-PLUS 2:''' Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. [https://doi.org/10.1016/j.cgh.2020.03.032 link to original article] [https://pubmed.ncbi.nlm.nih.gov/32205226/ PubMed] NCT02389621 | ||
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[[Category:Thrombocytopenia in liver disease regimens]] | [[Category:Thrombocytopenia in liver disease regimens]] | ||
[[Category:Disease-specific pages]] | [[Category:Disease-specific pages]] | ||
[[Category:Cytopenias]] | [[Category:Cytopenias]] | ||
Revision as of 12:16, 1 March 2023
Section editor transclusions See the thrombocytopenia reference page for general definitions and workup recommendations.
2 regimens on this page
2 variants on this page
|
Thrombocytopenia in liver disease with planned procedure
Avatrombopag monotherapy
Regimen
| FDA-recommended dose |
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Terrault et al. 2018 (ADAPT-2) | 2013-2017 | Phase 3 (E-esc) | Placebo | Superior primary endpoint |
| Terrault et al. 2018 (ADAPT-1) | 2014-2017 | Phase 3 (E-esc) | Placebo | Superior primary endpoint |
Growth factor therapy
- Avatrombopag (Doptelet) by the following laboratory-based criteria:
- Platelet count less than 40 x 109/L: 60 mg PO once per day on days 1 to 5
- Platelet count at least 40 and less than 50 x 109/L: 40 mg PO once per day on days 1 to 5
Procedure days were days 10 to 13
References
- ADAPT-1: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01972529
- ADAPT-2: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01976104
Lusutrombopag monotherapy
Regimen
| FDA-recommended dose |
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alkhouri et al. 2020 (L-PLUS 1) | 2013-2014 | Phase 3 (E-esc) | Placebo | Superior primary endpoint |
| Alkhouri et al. 2020 (L-PLUS 2) | 2015-2017 | Phase 3 (E-esc) | Placebo | Superior primary endpoint |
References
- L-PLUS 1: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed JapicCTI-132323
- L-PLUS 2: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed NCT02389621
Placebo
Regimen
| Study | Years of enrollment | Evidence | Comparator | Comparative Efficacy |
|---|---|---|---|---|
| Alkhouri et al. 2020 (L-PLUS 1) | 2013-2014 | Phase 3 (C) | Lusutrombopag | Inferior primary endpoint |
| Terrault et al. 2018 (ADAPT-2) | 2013-2017 | Phase 3 (C) | Avatrombopag | Inferior primary endpoint |
| Terrault et al. 2018 (ADAPT-1) | 2014-2017 | Phase 3 (C) | Avatrombopag | Inferior primary endpoint |
| Alkhouri et al. 2020 (L-PLUS 2) | 2015-2017 | Phase 3 (C) | Lusutrombopag | Inferior primary endpoint |
No active treatment.
References
- ADAPT-1: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01972529
- ADAPT-2: Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018 Sep;155(3):705-718. Epub 2018 May 17. link to original article PubMed NCT01976104
- L-PLUS 1: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed JapicCTI-132323
- L-PLUS 2: Alkhouri N, Imawari M, Izumi N, Osaki Y, Ochiai T, Kano T, Bentley R, Trevisani F. Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol. 2020 Oct;18(11):2600-2608.e1. Epub 2020 Mar 20. link to original article PubMed NCT02389621