Immunosuppressive treatment combined with nucleoside analog is superior to nucleoside analog only in the treatment of severe thrombocytopenia in patients with cirrhosis associated with hepatitis B in China: A multicenter, observational study

Abstract

No effective treatment has been identified for patients of liver cirrhosis (LC) associated with hepatitis B virus (HBV) and severe thrombocytopenia. We aimed to explore the effectiveness and safety of low-dose prednisone or cyclosporine A (CsA) combined with nucleoside analog (NA) in patients with severe thrombocytopenia associated with HBV-related LC. We included 145 consecutive compensated HBV-associated LC patients with severe thrombocytopenia between 1 January 2006 and 31 December 2013. We divided the patients into three groups by treatment strategy, including NA only (n = 57), NA plus prednisone (n = 46), and NA plus CsA (n = 42). We analyzed the platelet counts, bleeding events, liver function, replication of HBV, and outcomes in each group. At all time points during this observation, the platelet counts in prednisone or CsA group were higher than those in the NA only group. There are significant differences in the cumulative rates of bleeding events among the three groups. The platelet counts and treatment were factors associated with bleeding events in multivariate analysis. The differences in HBV-DNA negative rates, HBV-DNA elevated rates, normal serum alanine transaminase rates, serum alanine transaminase elevated more than two times the baseline rates, and HBeAg seropositive conversion ratio among the groups did not reach statistical significance. The adverse events in our study were, in general, mild and balanced among the three treatment groups. Treatment with low-dose prednisone or CsA plus NA could elevate the platelet counts and reduce the risk of bleeding events in HBV LC with severe thrombocytopenia.

Recombinant human thrombopoietin increases platelet count in severe thrombocytopenic patients with hepatitis B‐related cirrhosis: Multicentre real‐world observational study

“…Treatment with prednisone or cyclosporine A could increase platelet counts and reduce bleeding events in HBV LC, compared to treatment with NA alone. 11 This indicates that thrombocytopenia in patients with HBV LC could be related to multiple factors. However, some patients still did not have satisfactory effects.…”

“…We excluded other diseases or medicines that could cause thrombocytopenia in our final analysis. Treatment with prednisone or cyclosporine A could increase platelet counts and reduce bleeding events in HBV LC, compared to treatment with NA alone 11 …”

“…Routine blood examination, liver function and kidney function were measured weekly during the first month and then at monthly intervals thereafter. The serologic markers of hepatitis B and serum HBV‐DNA were tested every 3 months 11 …”

“…10 For patients with severe thrombocytopenia associated with HBV-related LC, low-dose prednisone plus nucleoside analogs (NAs) or cyclosporine A plus NAs could increase platelet counts and decrease the risk of bleeding. 11 However, these patients might require invasive procedures, and the efficacies of previous treatment regimens are limited.…”

Glucocorticoid Treatment Strategies in Liver Failure

“…Thus, GCs have not been widely used for the treatment of severe hepatitis B in clinic. However, in recent years, due to the new generation of nucleoside analogs (NA), using GCs to treat HBV related LF has become much safer (55)(56)(57).…”