Clinical efficacy of avatrombopag and recombinant human thrombopoietin in the treatment of chronic liver disease-associated severe thrombocytopenia: A real-world study

Yong-Shuai Wang; Wei Wang; Sai Zhang; Shen-Yu Zhang; Ai-Zong Shen; Wei Wang; Hua-Chuan Song; Huan-Zhang Yao; Rui-Peng Song; Fan-Zheng Meng; Lei Li; Bjoern Nashan; Ji-Zhou Wang; Lian-Xin Liu

doi:10.3389/fphar.2022.1009612

Clinical efficacy of avatrombopag and recombinant human thrombopoietin in the treatment of chronic liver disease-associated severe thrombocytopenia: A real-world study

Front Pharmacol. 2022 Oct 4:13:1009612. doi: 10.3389/fphar.2022.1009612. eCollection 2022.

Authors

Yong-Shuai Wang¹, Wei Wang², Sai Zhang¹, Shen-Yu Zhang¹, Ai-Zong Shen², Wei Wang³, Hua-Chuan Song¹, Huan-Zhang Yao¹, Rui-Peng Song¹, Fan-Zheng Meng¹, Lei Li⁴, Bjoern Nashan⁵, Ji-Zhou Wang^{1

6}, Lian-Xin Liu^{1

6}

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
² Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
³ Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
⁴ Department of Infectious Disease, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
⁵ Department of Organ transplant center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
⁶ Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, China.

Abstract

Purpose: To investigate the clinical efficacy of avatrombopag, an oral thrombopoietin receptor agonist, versus subcutaneous recombinant human thrombopoietin (rh-TPO) in the treatment of severe thrombocytopenia (TCP) associated with chronic liver disease (CLD). Methods: Clinical data of 250 patients with severe TCP associated with CLD were collected in a single hospital from January 2019 to January 2022. The main parameters measured were the therapeutic response rate, changes in platelets (PLTs), and adverse events. Propensity score matching (PSM) was used to avoid possible selection bias. Results: After PSM, a total of 154 patients were enrolled in the study: 77 in the avatrombopag group and 77 in the rh-TPO group. There was no statistically significant difference between the two groups in the effect of increasing the PLT count (Waldχ ² = 1.659, p = 0.198; Waldχ ² = 0.220, p = 0.639). In addition, no interaction between time and different medications was found (Waldχ ² = 0.540, p = 0.910; Waldχ ² = 1.273, p = 0.736). Interestingly, in the subgroup analysis, both before and after PSM, avatrombopag showed better clinical efficacy than rh-TPO in the treatment of TCP associated with CLD in Child‒Pugh Class A (88.89% vs. 63.41%, p =0.003; 81.33% vs. 61.76%, p = 0.043). Fewer patients reported dizziness in the avatrombopag group than in the rh-TPO group both before and after PSM (7.8% vs. 25.0%; 7.8% vs. 24.7%, p < 0.05). Conclusion: Both before and after PSM, avatrombopag showed better clinical efficacy than rh-TPO in the treatment of TCP associated with CLD in Child‒Pugh Class A and showed a lower incidence of dizziness in all patients.

Keywords: avatrombopag; chronic liver disease (CLD); efficacy; propensity scorematching (PSM); recombinant human thrombopoietin (rh-TPO); thrombocytopenia (TCP).