Safety and efficacy of partial splenic embolization in telaprevir-based triple therapy for chronic hepatitis C.
OBJECTIVE
Pegylated-interferon/ribavirin (peg-IFN/RBV) therapy with a protease inhibitor is the standard therapy for genotype 1b chronic hepatitis C. Despite improving treatment outcomes, patients with thrombocytopenia are often difficult to treat because interferon commonly exacerbates thrombocytopenia. In this study, partial splenic embolization (PSE) was performed in patients with hypersplenism-induced thrombocytopenia to determine the effectiveness of this method as a potential treatment.


METHODS
Patients were pretreated with PSE and then received triple combination therapy. The safety and efficacy of PSE was evaluated.


RESULTS
Eighteen patients were analyzed, including 12 patients with the interleukin 28B (IL28B) major genotype and 12 patients with the inosine triphosphatase (ITPA) major genotype. The median embolization rate with PSE was 70% (range: 40-85%). PSE increased the patients' platelet counts from 71.5×10(3) /μL (53-99×10(3) /μL) to 121.5×10(3) /μL (70-194×10(3) /μL; p=0.0002). The patients' platelet counts fluctuated above 50×10(3) /μL during the treatment. Specifically, the increase in the platelet count was significantly associated with the ITPA major genotype compared with the minor genotype (p=0.0057 at 2 weeks, p=0.0031 at 3 weeks, and p=0.0148 at 4 weeks). Adherence to peg-IFN-α2b was sufficient (1.38 μg/kg/week). The rapid viral response rate was 72.2% (13/18), the end of treatment response rate was 88.9% (16/18), and the sustained virological response (SVR) rate was 66.7% (12/18). The SVR rate for patients with the IL28B major genotype was 83.3% (10/12). No adverse effect due to PSE pretreatment was found in any patients. Furthermore, no patient discontinued treatment due to thrombocytopenia.


CONCLUSIONS
PSE, in conjunction with triple combination therapy, is a useful and safe method to treat genotype 1b chronic hepatitis C patients with hypersplenism-induced thrombocytopenia.
Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan.
Chisa
C
Kondo
Masanori
M
Atsukawa
Akihito
A
Tsubota
Noritomo
N
Shimada
Hiroshi
H
Abe
Norio
N
Itokawa
Ai
A
Nakagawa
Takeshi
T
Fukuda
Yoko
Y
Matsushita
Katsuhisa
K
Nakatsuka
Chiaki
C
Kawamoto
Katsuhiko
K
Iwakiri
Yoshio
Y
Aizawa
Choitsu
C
Sakamoto
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000235:genetics*; D006801:Humans; D006971:Hypersplenism / Q000150:complications / Q000628:therapy*; D016898:Interferon-alpha / Q000627:therapeutic use; D007372:Interferons; D007378:Interleukins / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000627:therapeutic use; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011755:Pyrophosphatases / Q000235:genetics; D012254:Ribavirin / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D000095022:Interferon Lambda; D000097630:Inosine Triphosphatase
D000998:Antiviral Agents; D016898:Interferon-alpha; D007372:Interferons; D007378:Interleukins; D009842:Oligopeptides; D011092:Polyethylene Glycols; D011755:Pyrophosphatases; D012254:Ribavirin; C000624353:interferon-lambda, human; D000095022:Interferon Lambda; C486464:telaprevir; C511829:ITPA protein, human; D000097630:Inosine Triphosphatase