Background Eltrombopag is a thrombopoietin mimetic indicated in immune thrombocytopenia when corticosteroids or splenectomy are not effective or splenectomy is contraindicated. No direct comparison exists with romiplostim. Purpose To evaluate the effectiveness and safety of eltrombopag since its inclusion in the pharmacotherapeutic guide. Materials and methods Retrospective study of patients treated August 2011 – February 2013. Demographic data, pretreatments, splenectomy, platelet count (PC) at the beginning, at five weeks and at the end of the treatment or study, adverse effects and discontinuation, were collected. Results 8 women and 1 man, median age 63 (24–78). Five were splenectomised, all of them pretreated with corticosteroids, 7 with azathioprine, Danatrol or dapsone and 7 with romiplostim. Before treatment with romiplostim median PC was 4,000/mm3 (3,000–25,000) and after five weeks 75% had ≥50,000. 3 patients discontinued for inefficacy, 1 for partial response with a high dose, 2 for adverse effects and one was changed to eltrombopag for oral route administration. At the start of eltrombopag administration the median PC was 6,000 (2,000–68,000), after five weeks 44% had ≥50,000. At the end of study 6 patients had discontinued treatment, two due to lack of response, one was intolerant, one refused treatment for his liver disease, one was splenectomised and another had a sustained response. 3 patients continued with eltrombopag for a median of 70 weeks (57–78) and at the end of the study median platelet count was 45,000 (34,000–60,000). Thromboembolic complications, cataracts, bone marrow reticulin or liver damage were not reported. Two patients reported irritability and fatigue and another headache. Conclusions Both romiplostim and eltrombopag increased platelet count ≥50,000/mm3 more than placebo. Advantages of eltrombopag are oral versus subcutaneous administration and easier dosing. In an indirect comparison romiplostim achieved a better platelet response after 4 weeks of treatment, like in our study, but we observed more discontinuation with romiplostim due to lack of response or partial response (57% vs. 22%). No conflict of interest.
Background Interleukin-28B genetic polymorphism is a key predictor of response to peginterferon-ribavirin treatment in hepatitis C virus (HCV) genotype 1 infection (HCVg1i), CC interleukin-28B genotype (IL28Bg) being highly predictive of efficacy. There is a range of genotypes as well as responses to treatment, for example see the REALISE study . Main genotypes are IL28Bg CT, CC and TT. Purpose To assess the role of IL28Bg as a predictor of response in HCVg1i patients treated with telaprevir-based treatment. Materials and methods Retrospective study of patients treated with peginterferon-ribavirin-telaprevir. Demographic and pathological data, response at 4 and 12 weeks (HCV-RNA <1000) and at 24, 36, 48 weeks of treatment (HCV-RNA undetectable), sustained virological response 12 weeks after treatment (SVR12), adverse effects and discontinuation were collected in an Access database and analysed with SPSS vs12. Results 73 patients (53 male), median age of 51 (34–76) years, 63.4% genotype 1b, 87.7% mono-infected, 68.5% pretreated (mainly relapsers 60%), and 56.2% fibrosis F3-F4. 65.8% were IL28Bg CT, 19.2% CC, 15.1% TT. 32.9% discontinued treatment. Among IL28Bg groups no difference was found either in baseline data or in response at 4,12, 24, 36 and 48 weeks of treatment and SVR12, but a lower response in TT individuals was observed in weeks 36 and 48 (85.7% vs. 100% in CT and CC) and lower SVR12 with a virological failure in TT (33.3%) and CT (12.5%), not being observed in CC. Anaemia (haemoglobin level <10 g/dL) was more frequent in CC (50%) nevertheless significant differences were not observed. There was no difference in cutaneous rash. Within each group, discontinuation was higher in CT (35.4%) and CC (35.7%) being mainly due to virological failure (52.9%) and adverse effects (60%), respectively. Conclusions IL28Bg seemed to show a very good SVR12 in the CC group, an increase in virological failure being observed in CT and TT. Published studies suggest that the IL28B genotype has a limited impact on sustained virological response (SVR) rates with telaprevir-based treatment, achieving an improvement in all IL28B genotypes. In our study SVR12 might be influenced by IL28Bg. Further SVR data is needed. No conflict of interest.
Background Hepatitis C virus genotype 1a (HCV-1a) is a predictor of poor response to peginterferon-ribavirin treatment, which has been associated with a lower resistance barrier, compared to HCV genotype 1b (HCV-1b). Variations in the human IL28B genotypes CC, CT or TT have also been associated with a person’s response to treatment for hepatitis C. Studies have shown that people with the CC variation respond better to treatment with pegylated-interferon and ribavirin than those with the CT or TT variations.; Purpose To assess the differences in effectiveness between HCV-1a and HCV-1b in patients with HCV treated with telaprevir-based treatment. Materials and methods Retrospective study of patients treated with peginterferon-ribavirin-telaprevir. Demographic and pathological data, response at 4 and 12 weeks (HCV-RNA <1000) and at 24, 36, 48 weeks of treatment (HCV-RNA undetectable), sustained virological response after 12 weeks of treatment (SVS12), adverse effects and discontinuation were collected in an Access database and analysed with SPSS vs12. Results Of 79 patients (57 male), 59.5% were infected with HCV-1b, 59.5% presented fibrosis F3-F4 and 70.9% were pretreated (mainly relapsers 58.9%). Of those with HCV-1a 57.7% had the CT variant of the IL28 genotype, 26.9% CC and 15.4% TT and in those with HCV-1b 71.1% had the CT variant, 15.6% CC and 13.3% TT. There were significant differences in age: a median age of 50 (34–66) in HCV-1a-infected patients and 57 (42–76) in HCV-1b (p = 0.002). Of patients with HCV-1a 68% were monoinfected and 32% had both variants. Of patients with HCV-1b 96.3% were HCV monoinfected and 3.7% were coinfected. 34.2% discontinued treatment. No statistical difference was found in response at 4, 12, 24, 36 and 48 weeks of treatment and SVR12, but there was a trend towards a lower SVR12 in HCV-1b (75% vs. 100% in HCV-1a). No significant differences were found in cutaneous rash or anaemia (haemoglobin level <10 g/dL). Within each group discontinuation was higher in HCV-1a (43.8%) than in HCV-1b (27.7%) although it was not statistically significant, mainly due to virological failure (64.3%) and adverse effects (46.2%). Conclusions The sustained virological response (SVR12) rates in HCV-1a group are better than in HCV-1b, not worse, which might be attributed to a higher frequency of genotype CC and a lower frequency of CT in people infected with it than in those infected with HCV-1b. Further studies are required because of the small sample size and more data of sustained virological response are needed. No conflict of interest.
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