title: Partial splenic embolization facilitates the adherence to peginterferon in chronic hepatitis C with thrombocytopenia.
abstract: OBJECTIVE
  Platelet counts before starting the treatment affect the discontinuation and dose reduction of peginterferon in chronic hepatitis C. Thrombocytopenia leads to failure to achieve sustained virological response. This study was undertaken to evaluate the efficacy of partial splenic embolization (PSE) prior to starting peginterferon therapy combined with ribavirin in chronic hepatitis C patients showing thrombocytopenia.
  
  
  METHODS
  We compared the clinical features of 11 patients receiving PSE (PSE group) prior to starting the combined therapy with those of 13 patients not receiving PSE (non-PSE group). All of the patients showed platelet counts ≤12×10(4)/mm(3) and serum hepatitis C virus-RNA levels ≥100 KIU/mL at baseline. The end-point of PSE was a volume of splenic infarction over 75%. Peginterferon alpha-2b at a dose of 1.2 µg/kg was administered by subcutaneous injection once a week. The dose of ribavirin was weight adjusted.
  
  
  RESULTS
  PSE was successfully performed without serious adverse events. The period from PSE to starting the combined therapy was 14 (6-27) days. After PSE, platelet counts were significantly increased. In PSE group, platelet counts during the combined therapy were maintained above those at baseline. In non-PSE group, platelet counts at the 2nd week after the start of the combined therapy significantly decreased to less than those at baseline. Overall, 80% adherence to expected peginterferon dose was not achieved in 5 patients (45%) of PSE group and in 11 (85%) of non-PSE group (p=0.043).
  
  
  CONCLUSIONS
  Increased platelet counts after PSE facilitates the adherence to peginterferon therapy in chronic hepatitis C patients with thrombocytopenia.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Miyatake
authors.forename: Atsushi
authors.initials: A
authors.lastname: Imagawa
authors.forename: Morihito
authors.initials: M
authors.lastname: Nakatsu
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ando
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hirohata
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D004621:Embolization, Therapeutic; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage; D013157:Splenic Artery; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b