Non-cirrhotic thrombocytopenic patients with hepatitis C virus: Characteristics and outcome of antiviral therapy

Edoardo G. Giannini, Nezam H. Afdhal, Samuel H. Sigal, Andrew J. Muir, K. Rajender Reddy, Shanthi Vijayaraghavan, Magdy Elkashab, Manuel Romero-Gómez, Geoffrey M. Dusheiko, Malini Iyengar, Sandra Y. Vasey, Fiona M. Campbell, Dickens Theodore

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and Aim: Thrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. Methods: The study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE<0.4) and cirrhosis-related (FibroSURE≥0.75) thrombocytopenia. Results: Compared with patients with cirrhosis-related thrombocytopenia (n=995; 78.5%), non-cirrhotic patients with thrombocytopenia (n=59; 4.6%) were younger (mean age [95% confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P<0.0001), predominantly female (64% [51-76] vs 30% [27-33]; P<0.0001), and less frequently had a Model for End-Stage Liver Disease score ≥10 (24% [14-37] vs 45% [42-49]; P=0.0012), low albumin levels (≤35 g/L; 2% [0-9] vs 32% [29-35]; P<0.0001), and prevalence of diabetes mellitus (3% [0-12] vs 21% [19-24]; P=0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46% [95% CI, 33-59] vs 16% [14-18]; P<0.0001). Conclusions: Patients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.

Original languageEnglish (US)
Pages (from-to)1301-1308
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume30
Issue number8
DOIs
StatePublished - Aug 1 2015
Externally publishedYes

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Hepacivirus
Antiviral Agents
Thrombocytopenia
Fibrosis
Virus Diseases
Therapeutics
Chronic Hepatitis C
Confidence Intervals
End Stage Liver Disease
Ribavirin
Interferons
Albumins
Diabetes Mellitus
Cross-Sectional Studies
Viruses
Liver

Keywords

  • Cirrhosis
  • Eltrombopag
  • Hepatitis C virus
  • Interferon
  • Platelets

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Non-cirrhotic thrombocytopenic patients with hepatitis C virus : Characteristics and outcome of antiviral therapy. / Giannini, Edoardo G.; Afdhal, Nezam H.; Sigal, Samuel H.; Muir, Andrew J.; Reddy, K. Rajender; Vijayaraghavan, Shanthi; Elkashab, Magdy; Romero-Gómez, Manuel; Dusheiko, Geoffrey M.; Iyengar, Malini; Vasey, Sandra Y.; Campbell, Fiona M.; Theodore, Dickens.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 30, No. 8, 01.08.2015, p. 1301-1308.

Research output: Contribution to journalArticle

Giannini, EG, Afdhal, NH, Sigal, SH, Muir, AJ, Reddy, KR, Vijayaraghavan, S, Elkashab, M, Romero-Gómez, M, Dusheiko, GM, Iyengar, M, Vasey, SY, Campbell, FM & Theodore, D 2015, 'Non-cirrhotic thrombocytopenic patients with hepatitis C virus: Characteristics and outcome of antiviral therapy', Journal of Gastroenterology and Hepatology (Australia), vol. 30, no. 8, pp. 1301-1308. https://doi.org/10.1111/jgh.12942
Giannini, Edoardo G. ; Afdhal, Nezam H. ; Sigal, Samuel H. ; Muir, Andrew J. ; Reddy, K. Rajender ; Vijayaraghavan, Shanthi ; Elkashab, Magdy ; Romero-Gómez, Manuel ; Dusheiko, Geoffrey M. ; Iyengar, Malini ; Vasey, Sandra Y. ; Campbell, Fiona M. ; Theodore, Dickens. / Non-cirrhotic thrombocytopenic patients with hepatitis C virus : Characteristics and outcome of antiviral therapy. In: Journal of Gastroenterology and Hepatology (Australia). 2015 ; Vol. 30, No. 8. pp. 1301-1308.
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abstract = "Background and Aim: Thrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. Methods: The study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE<0.4) and cirrhosis-related (FibroSURE≥0.75) thrombocytopenia. Results: Compared with patients with cirrhosis-related thrombocytopenia (n=995; 78.5{\%}), non-cirrhotic patients with thrombocytopenia (n=59; 4.6{\%}) were younger (mean age [95{\%} confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P<0.0001), predominantly female (64{\%} [51-76] vs 30{\%} [27-33]; P<0.0001), and less frequently had a Model for End-Stage Liver Disease score ≥10 (24{\%} [14-37] vs 45{\%} [42-49]; P=0.0012), low albumin levels (≤35 g/L; 2{\%} [0-9] vs 32{\%} [29-35]; P<0.0001), and prevalence of diabetes mellitus (3{\%} [0-12] vs 21{\%} [19-24]; P=0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46{\%} [95{\%} CI, 33-59] vs 16{\%} [14-18]; P<0.0001). Conclusions: Patients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.",
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T1 - Non-cirrhotic thrombocytopenic patients with hepatitis C virus

T2 - Characteristics and outcome of antiviral therapy

AU - Giannini, Edoardo G.

AU - Afdhal, Nezam H.

AU - Sigal, Samuel H.

AU - Muir, Andrew J.

AU - Reddy, K. Rajender

AU - Vijayaraghavan, Shanthi

AU - Elkashab, Magdy

AU - Romero-Gómez, Manuel

AU - Dusheiko, Geoffrey M.

AU - Iyengar, Malini

AU - Vasey, Sandra Y.

AU - Campbell, Fiona M.

AU - Theodore, Dickens

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background and Aim: Thrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. Methods: The study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE<0.4) and cirrhosis-related (FibroSURE≥0.75) thrombocytopenia. Results: Compared with patients with cirrhosis-related thrombocytopenia (n=995; 78.5%), non-cirrhotic patients with thrombocytopenia (n=59; 4.6%) were younger (mean age [95% confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P<0.0001), predominantly female (64% [51-76] vs 30% [27-33]; P<0.0001), and less frequently had a Model for End-Stage Liver Disease score ≥10 (24% [14-37] vs 45% [42-49]; P=0.0012), low albumin levels (≤35 g/L; 2% [0-9] vs 32% [29-35]; P<0.0001), and prevalence of diabetes mellitus (3% [0-12] vs 21% [19-24]; P=0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46% [95% CI, 33-59] vs 16% [14-18]; P<0.0001). Conclusions: Patients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.

AB - Background and Aim: Thrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. Methods: The study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE<0.4) and cirrhosis-related (FibroSURE≥0.75) thrombocytopenia. Results: Compared with patients with cirrhosis-related thrombocytopenia (n=995; 78.5%), non-cirrhotic patients with thrombocytopenia (n=59; 4.6%) were younger (mean age [95% confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P<0.0001), predominantly female (64% [51-76] vs 30% [27-33]; P<0.0001), and less frequently had a Model for End-Stage Liver Disease score ≥10 (24% [14-37] vs 45% [42-49]; P=0.0012), low albumin levels (≤35 g/L; 2% [0-9] vs 32% [29-35]; P<0.0001), and prevalence of diabetes mellitus (3% [0-12] vs 21% [19-24]; P=0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46% [95% CI, 33-59] vs 16% [14-18]; P<0.0001). Conclusions: Patients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.

KW - Cirrhosis

KW - Eltrombopag

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KW - Interferon

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