Considerations in the management of hepatitis C virus-related thrombocytopenia with eltrombopag.
Thrombocytopenia is a common clinical problem in HCV-infected cases. Multiple studies have consistently shown a rise in platelet count following a successful HCV treatment thus proving a cause-effect relationship between the two. Although, many therapeutic strategies have been tried in the past to treat HCV-related thrombocytopenia (e.g. interferon dose reductions, oral steroids, intravenous immunoglobulins, splenectomy etc), the success rates have been variable and not always reproducible. After the cessation of clinical trials of PEG-rHuMGDF due to immunogenecity issues, the introduction of non-immunogenic second-generation thrombopoietin-mimetics (eltrombopag and Romiplostim) has opened up a novel way to treat HCV-related thrombocytopenia. Although the data is still sparse, eltrombopag therapy has shown to successfully achieve the primary endpoint platelet counts of >/=50,000/muL in phase II& III, randomized, double-blind, placebo-controlled trials. Likewise, though it is premature to claim safety of this drug especially in high-risk patient groups, reported side effects in the published literature were of insufficient severity to require discontinuation of the drug. Based on the current and emerging evidence, a review of the pharmacologic basis, pharmacokinetics, therapeutic efficacy, safety profile and future considerations of eltrombopag in the context of HCV-related thrombocytopenia is given in this article. A MEDLINE search was conducted (1990 to August 2009) using the search terms eltrombopag, HCV, thrombocytopenia.
Danish
Fazal A
FA
Princess of Wales Hospital, Coity Road, Bridgend, United Kingdom. drfazal2000@yahoo.com
Koul
Salman S
SS
Subhani
Fazal R
FR
Rabbani
Ahmed E
AE
Yasmin
Saeeda
S
D001565:Benzoates / Q000627:therapeutic use*; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; C520809:eltrombopag