Thrombopoietin receptor agonist is more effective than platelet transfusion for chronic liver disease with thrombocytopenia, shown by propensity score matching
Thrombopoietin receptor agonist is more effective than platelet transfusion for chronic liver disease with thrombocytopenia, shown by propensity score matching
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DOI：
10.1111/hepr.13530
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发表时间：
2020-06-30
影响因子：
4.2
通讯作者：
Itoi, Takao
中科院分区：
文献类型：
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作者：
Furuichi, Yoshihiro;Takeuchi, Hirohito;Itoi, Takao
目的 血小板生成素受体激动剂 lusutrombopag 最近被用于治疗慢性肝病引起的血小板减少症。然而，尚无研究比较 lusutorombopag 和血小板输注的效果。因此，我们的目的是通过倾向评分匹配来阐明 lusutrombopag 与血小板输注相比的疗效和应答者比例。方法 纳入200例血小板减少症患者（90例lusutrombopag，110例血小板输注），采用倾向评分匹配法对年龄、肝功能、肾功能、血小板计数、外周血计数、脾脏大小进行匹配。最终，纳入了 52 名患者（26 名 lusutrombopag，26 名血小板输注）。主要终点是血小板计数增加。次要终点是反应者的比例、持续作用的持续时间、不良事件的发生率以及与血小板计数增加相关的预测因素。结果 血小板相对于基线的中位增加为 48 x 10(3)/μL 对比 9.5 x 10(3)/μL（lusutrombopag 与输血，P < 0.0001）。响应者的比例（增加>10 x 10(3)/μL）为100% vs 50.0% (P < 0.0001)。持续效果的中位持续时间（增加 >50 x 10(3)/μL）为 10 天与 2 天（P < 0.0001）。不良事件的发生率为 7.7% vs 50.0% (P = 0.036)。通过多元回归分析，与血小板增加相关的预测因素是血红蛋白和脾脏大小。结论 Lusutrombopag对慢性肝病患者的疗效优于血小板输注。 lusutrombopag 组的反应者比例、作用持续时间和不良事件无发生率较高。
Aim The thrombopoietin receptor agonist, lusutrombopag, was recently adapted for treatment of thrombocytopenia in chronic liver disease. However, no studies have compared the effects of lusutorombopag and platelet transfusion. Therefore, we aimed to clarify the efficacy and proportion of responders of lusutrombopag compared with platelet transfusion, by propensity score matching. Methods A total of 200 patients (90 lusutrombopag, 110 platelet transfusion) with thrombocytopenia were enrolled, and matched for age, liver function, renal function, platelet count, peripheral blood count, and spleen size, using the propensity score-matching method. Finally, 52 patients (26 lusutrombopag, 26 platelet transfusion) were included. The primary end-point was an increase in platelet count. Secondary end-points were the proportion of responders, duration of the sustained effect, incidence of adverse events, and predictors associated with an increase in platelet count. Results The median increase in platelets from baseline was 48 x 10(3)/mu L versus 9.5 x 10(3)/mu L (lusutrombopag vs. transfusion,P < 0.0001). The proportion of responders (increase of >10 x 10(3)/mu L) was 100% versus 50.0% (P < 0.0001). Median duration of the sustained effect (increase of >50 x 10(3)/mu L) was 10 versus 2 days (P < 0.0001). The incidence of adverse events was 7.7% versus 50.0% (P = 0.036). Predictors associated with an increase in platelets were hemoglobin and spleen size by multiple regression analysis. Conclusion Lusutrombopag was more effective in chronic liver disease patients than platelet transfusion. The proportion of responders, effect duration, and non-incidence rate of adverse events were higher in the lusutrombopag group.