Thrombocytopenia (T) in patients with chronic hepatitis C: Management with interleukin 11

Mendenhall, Charles L.; Shakir, Abdur; Zoiss, Elizabeth A.; Reese, Catrina; Bui, Hai X.; Goldberg, Stephen J.; Roselle, Gary A.

doi:10.1016/s0016-5085(03)83891-x

Cited by 2 publications

(3 citation statements)

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“…In the second study, an abstract by other authors reported that rhIL‐11 was effective at preventing dose reduction or therapy discontinuation in 25% of the patients undergoing IFN or pegylated‐IFN therapy for chronic hepatitis C. It was also useful in order to safely allow anti‐viral therapy to be started in 5% of these patients. The only side‐effect reported in this study was fluid retention that occurred in 5% of the patients 87 …”

Section: Cytokines With Thrombopoietic Activitymentioning

confidence: 65%

Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options

Giannini

2006

Aliment Pharmacol Ther

175

171

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Summary In patients with liver disease, thrombocytopenia is a clinical feature that may represent an obstacle to invasive diagnostic or therapeutic procedures, chemotherapy, and anti‐viral treatment. Stimulation of the bone marrow is the most promising therapeutic intervention for thrombocytopenia in patients with chronic liver disease. The description of thrombopoietin and its (de)regulation in patients with chronic liver disease have disclosed new treatment opportunities. Indeed, pharmacologic treatment options for thrombocytopenia can be divided into treatments targeted at the thrombopoietin receptor (synthetic thrombopoietins and thrombopoietin‐mimetic agents), and use of cytokines with general thrombopoietic potential. Unfortunately, use of synthetic thrombopoietin was hampered by the development of neutralizing antibodies, and thrombopoietin mimetic agents have not yet entered clinical studies. Interleukin‐11 proved to be useful in increasing platelet count in patients with chronic liver disease, although its use is limited by side‐effects. Erythropoietin has shown promising results in improving thrombocytopenia in cirrhotic patients. In patients with chronic liver disease, safe and well‐tolerated treatments aimed at improving thrombocytopenia are still lacking. Larger studies are needed to evaluate and better characterize the thrombopoietic potential of erythropoietin. Human studies with thrombopoietin‐mimetic agents are eagerly awaited in order to assess both effectiveness and safety of these drugs.

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Section: Cytokines With Thrombopoietic Activitymentioning

confidence: 65%

Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options

Giannini

2006

Aliment Pharmacol Ther

175

171

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“…Recombinant human IL-11 (rhIL-11, Oprelvekin), approved for the management of chemotherapy-related thrombocytopenia, has also been shown to increase platelet count in chronic HCV infection. 62 – 64 In a study by Lawitz et al, use of rhIL-11 (Oprelvekin) in patients with advanced liver disease associated with chronic HCV infection caused a 38% increase in mean platelet count from baseline after 12 weeks of therapy, along with an improvement in the mean Knodell Histology Activity Index from 7.3 to 5.9 (p= 0.006). 65 However, the platelet level tends to fall back on discontinuing the drug.…”

Section: Managementmentioning

confidence: 99%

“… 62 It also causes fluid retention in most patients, and this can be a significant management problem in patients with decompensated cirrhosis. 64 …”

Section: Managementmentioning

confidence: 99%

Thrombocytopenia in Patients With Chronic Hepatitis C Virus Infection

Dahal¹,

Upadhyay²,

Banjade³

et al. 2017

Mediterr J Hematol Infect Dis

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Thrombocytopenia in patients with chronic hepatitis C virus (HCV) infection is a major problem. The pathophysiology is multifactorial, with auto-immunogenicity, direct bone marrow suppression, hypersplenism, decreased production of thrombopoietin and therapeutic adverse effect all contributing to thrombocytopenia in different measures. The greatest challenge in the care of chronic HCV patients with thrombocytopenia is the difficulty in initiating or maintaining IFN containing anti-viral therapy. Although at present, it is possible to avoid this challenge with the use of the sole Direct Antiviral Agents (DAAs) as the primary treatment modality, thrombocytopenia remains of particular interest, especially in cases of advanced liver disease. The increased risk of bleeding with thrombocytopenia may also impede the initiation and maintenance of different invasive diagnostic and therapeutic procedures. While eradication of HCV infection itself is the most practical strategy for the remission of thrombocytopenia, various pharmacological and non-pharmacological therapeutic options, which vary in their effectiveness and adverse effect profiles, are available. Sustained increase in platelet count is seen with splenectomy and splenic artery embolization, in contrast to only transient rise with platelet transfusion. However, their routine use is limited by complications. Different thrombopoietin analogues have been tried. The use of synthetic thrombopoietins, such as recombinant human TPO and pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMDGF), has been hampered by the development of neutralizing antibodies. Thrombopoietin-mimetic agents, in particular, eltrombopag and romiplostim, have been shown to be safe and effective for HCV-related thrombocytopenia in various studies, and they increase platelet count without eliciting any immunogenicity Other treatment modalities including newer TPO analogues-AMG-51, PEG-TPOmp and AKR-501, recombinant human IL-11 (rhIL-11, Oprelvekin), recombinant human erythropoietin (rhEPO), danazol and L-carnitine have shown promising early result with improving thrombocytopenia. Thrombocytopenia in chronic HCV infection remain a major problem, however the recent change in DAAs without IFN, as the frontline therapy for HCV, permit to avoid the dilemmas associated with initiating or maintaining IFN based anti-viral therapy.

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Thrombocytopenia (T) in patients with chronic hepatitis C: Management with interleukin 11

Cited by 2 publications

References 0 publications

Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options

Review article: thrombocytopenia in chronic liver disease and pharmacologic treatment options

Thrombocytopenia in Patients With Chronic Hepatitis C Virus Infection

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