Aim Lusutrombopag is approved for the treatment of thrombocytopenia in chronic liver disease patients undergoing invasive procedures. This real‐world surveillance assesses the safety and effectiveness of lusutrombopag in Japan. Methods This ongoing, multicenter, prospective, real‐world surveillance is collecting data from case report forms between October 2016 and May 2021. Interim data up to September 2018 were used to evaluate safety (adverse events and adverse drug reactions [ADRs]) and effectiveness (proportion of patients avoiding preoperative platelet transfusion and change in platelet count from baseline). Results The safety analysis set included 331 patients. The mean baseline platelet count was 46.2 ± 13.7 × 109/L. Of 377 invasive procedures, radiofrequency ablation (110 procedures, 29.2%) was the most frequent. The mean time from starting lusutrombopag treatment to invasive procedure was 12.3 days. Incidences of serious adverse events and ADRs were 8.76% and 3.32%, respectively. Six cases (1.81%) of portal vein thrombosis were considered serious adverse events; of these, four cases (1.21%) were classified as serious ADRs. Of 300 patients who underwent an invasive procedure (excluding those with platelet transfusion refractoriness), 282 (94.0%) avoided preoperative platelet transfusion. In patients with platelet measurements before and after lusutrombopag administration who did not undergo platelet transfusion, the mean maximum change in platelet count from baseline was 41.7 ± 31.4 × 109/L (range, −6 to 276; n = 286). All patients receiving second (n = 20) and third (n = 1) treatments avoided preoperative platelet transfusion without developing any ADRs. Conclusions This real‐world surveillance further supports the safety and effectiveness of lusutrombopag in patients with chronic liver disease undergoing invasive procedures.

Introduction Patients with thrombocytopenia and chronic liver disease are at increased risk of bleeding during invasive procedures due to low platelet counts. Lusutrombopag, an orally active thrombopoietin receptor agonist, increases platelet count and reduces the need for platelet transfusion in chronic liver disease patients with thrombocytopenia undergoing a planned invasive procedure. The safety of lusutrombopag in patients with Child–Pugh class C chronic liver disease is not known. The present analysis was performed to determine the pharmacokinetics, efficacy, and safety of lusutrombopag in patients with Child–Pugh class C chronic liver disease. Methods Data for patients with Child–Pugh class C chronic liver disease were collected from three data sets: a phase 1/2 Child–Pugh class C study ( n = 5) (JapicCTI-163289 [Japan Pharmaceutical Information Center]), a phase 3 pivotal study (L-PLUS 2, n = 3) (NCT02389621 [Clinicaltrials.gov]), and ongoing post-marketing surveillance ( n = 27) (JapicCTI-163432 [Japan Pharmaceutical Information Center]). Patients received lusutrombopag at 3 mg for up to 7 days. Safety and efficacy assessments were collected from two clinical studies and the post-marketing surveillance; pharmacokinetic data were collected from the phase 1/2 study. Results Mean C max and AUC 0– τ were lower in Child–Pugh class C patients than Child–Pugh class A and B; individual patients’ C max and AUC 0– τ values overlapped among Child–Pugh classes. In lusutrombopag patients who did not receive platelet transfusion ( n = 4 in phase 1/2, n = 1 in phase 3, n = 24 in post-marketing surveillance), the median (range) maximum platelet count was 88.5 × 10 9 /L (54–105 × 10 9 /L), 80 × 10 9 /L, and 91 × 10 9 /L (41–186 × 10 9 /L; n = 23), respectively. There were no treatment-related adverse events or treatment-related serious adverse events. One patient from the phase 1/2 study had a non-serious portal vein thrombosis, which was not considered treatment-related. Conclusions The analysis presented in this study suggests that lusutrombopag increases platelet counts in Child–Pugh class C patients and is safe and well tolerated in this patient population. Trial Registration L-PLUS 2: NCT02389621 (Clinicaltrials.gov). Phase 1/2: JapicCTI-163289 (Japan Pharmaceutical Information Center [JAPIC]). Post-marketing surveillance: JapicCTI-163432 (JAPIC). Supplementary Information ...

Background: Lusutrombopag is an oral, small molecule thrombopoietin receptor agonist approved in Japan and US for improvement of thrombocytopenia, and in EU for severe thrombocytonia, associated with chronic liver disease in patients undergoing planned invasive procedures. The degree of thrombocytopenia may impact the treatment response to lusutrombopag and need for platelet transfusion. Aims: This analysis evaluates the increase in platelet count and maximum platelet count achieved according to baseline platelet count. Methods: L-PLUS 1 and L-PLUS 2 were two similar phase 3 multicenter, randomized, double-blind, placebo-controlled studies; L-PLUS 1 (JapicCTI-132323) was conducted in Japan and LPLUS 2 (NCT02389621) was conducted globally. Patients with thrombocytopenia due to chronic liver disease received lusutrombopag 3 mg or placebo for up to 7 days prior to an invasive procedure scheduled 9-14 days after randomization. Patients were adults with platelet count (x10 9 /L) <50 at baseline. Platelet transfusion was mandated if the platelet count remained <50 no more than two days prior to the planned invasive procedure. The change in platelet count over time was a key efficacy endpoint. A per-protocol population from the two trials was integrated for this analysis; post-platelet transfusion platelet counts were excluded from the analysis when calculating the proportion of patients who met a criterion and summary statistics for maximum platelet counts. Results: 312 patients were randomized. Of the 270 patients in the per-protocol population, 78.1% of patients in the lusutrombopag group (n = 137) achieved a platelet count ≥50 at least once during the study versus 30.1% of patients in the placebo group (n = 133). The platelet count increased by double or more in 47.4% and 3.8% in the lusutrombopag and placebo groups, respectively, and increased by 50% or more in 77.4% and 12.8%, respectively. The average maximum platelet count in the lusutrombopag group stratified according to baseline platelet count of <20, ≥20-<30, ≥30-<35, ≥35-<40, and ≥40-<50 was 56, 45, 64, 82, and 87, respectively (Figure). The average maximum change in platelet count in these strata were +41, 21, 32, 45, and 42, respectively.

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