title: Efficacy and safety of splenectomy in telaprevir-based triple therapy for chronic hepatitis C patients with thrombocytopenia and advanced fibrosis.
abstract: OBJECTIVE
  Thrombocytopenia (TCP) of chronic hepatitis C patients with cirrhosis has a negative impact on the management of interferon-based treatment. The aim of this study is to evaluate the efficacy and safety of telaprevir-based triple therapy for patients who have undergone splenectomy (Spx).
  
  
  METHODS
  This prospective, multicenter study consisted of 80 patients, including 32 Spx and 48 non-Spx/TCP (platelet count: 60-99 × 10(9) /L) patients with advanced fibrosis infected with hepatitis C virus genotype 1b. All received 12 weeks of telaprevir in combination with 24 weeks of pegylated interferon (PEG-IFN) α2b and ribavirin.
  
  
  RESULTS
  The sustained virological response (SVR) rate of the Spx group (75.0%) was significantly higher than that of the non-Spx/TCP group (52.1%) (P < 0.05). Under favorable conditions such as treatment-naïve/prior relapse and interleukin-28B (IL28B) TT allele (rs8099917), the SVR rates of the Spx group were significantly higher than those of the non-Spx/moderate TCP (60-79 × 10(9) /L) groups (91.3% vs 50.0% and 93.8% vs 37.5%, respectively; both P < 0.05). Adequate PEG-IFNα2b adherence was associated with SVR. However, the percentage of patients who achieved 80% adherence to PEG-IFNα2b in the non-Spx/moderate TCP (42.9%) group was significantly lower than that of the Spx (79.3%) and non-Spx/mild TCP (80-99 × 10(9) /L) (80.0%) groups. Treatment discontinuation due to adverse effects and the development of bacterial infection did not differ between the Spx and non-Spx/TCP groups.
  
  
  CONCLUSIONS
  The increase of platelet count after Spx contributed to treatment success, especially for moderate to severe TCP patients who are treatment-naïve/prior relapse or IL28B TT allele.
authors.affiliation: Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ogawa
authors.forename: Norihiro
authors.initials: N
authors.lastname: Furusyo
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakamuta
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajiwara
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nomura
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Dohmen
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takahashi
authors.forename: Takeaki
authors.initials: T
authors.lastname: Satoh
authors.forename: Koichi
authors.initials: K
authors.lastname: Azuma
authors.forename: Akira
authors.initials: A
authors.lastname: Kawano
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kotoh
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimoda
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
authors.forename: Jun
authors.initials: J
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000483:Alleles; D000998:Antiviral Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage; D007372:Interferons; D007378:Interleukins / Q000235:genetics; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000008:administration & dosage*; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012254:Ribavirin / Q000008:administration & dosage; D012720:Severity of Illness Index; D013156:Splenectomy; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult; D000095022:Interferon Lambda
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D007372:Interferons; D007378:Interleukins; D009842:Oligopeptides; D011092:Polyethylene Glycols; D011994:Recombinant Proteins; D012254:Ribavirin; C000624353:interferon-lambda, human; D000095022:Interferon Lambda; C486464:telaprevir; C417083:peginterferon alfa-2b
keywords: cirrhosis; hepatitis C virus; splenectomy; telaprevir; thrombocytopenia