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Efficacy and safety of splenectomy in telaprevir‐based triple therapy for chronic hepatitis C patients with thrombocytopenia and advanced fibrosis
Author(s) -
Ogawa Eiichi,
Furusyo Norihiro,
Nakamuta Makoto,
Kajiwara Eiji,
Nomura Hideyuki,
Dohmen Kazufumi,
Takahashi Kazuhiro,
Satoh Takeaki,
Azuma Koichi,
Kawano Akira,
Tanabe Yuichi,
Kotoh Kazuhiro,
Shimoda Shinji,
Akahoshi Tomohiko,
Maehara Yoshihiko,
Hayashi Jun
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12619
Subject(s) - medicine , telaprevir , gastroenterology , pegylated interferon , ribavirin , discontinuation , splenectomy , cirrhosis , adverse effect , hepatitis c virus , immunology , virus , spleen
Background and Aim Thrombocytopenia ( TCP ) of chronic hepatitis C patients with cirrhosis has a negative impact on the management of interferon‐based treatment. The aim of this study is to evaluate the efficacy and safety of telaprevir‐based triple therapy for patients who have undergone splenectomy ( Spx ). Methods This prospective, multicenter study consisted of 80 patients, including 32 Spx and 48 non‐ Spx / TCP (platelet count: 60–99 × 10 9 /L) patients with advanced fibrosis infected with hepatitis C virus genotype 1b. All received 12 weeks of telaprevir in combination with 24 weeks of pegylated interferon ( PEG ‐ IFN ) α2b and ribavirin. Results The sustained virological response ( SVR ) rate of the Spx group (75.0%) was significantly higher than that of the non‐ Spx / TCP group (52.1%) ( P < 0.05). Under favorable conditions such as treatment‐naïve/prior relapse and interleukin‐28 B ( IL 28 B ) TT allele (rs8099917), the SVR rates of the Spx group were significantly higher than those of the non‐ Spx /moderate TCP (60–79 × 10 9 /L) groups (91.3% vs 50.0% and 93.8% vs 37.5%, respectively; both P < 0.05). Adequate PEG ‐ IFN α2b adherence was associated with SVR . However, the percentage of patients who achieved 80% adherence to PEG ‐ IFN α2b in the non‐Spx/moderate TCP (42.9%) group was significantly lower than that of the Spx (79.3%) and non‐ Spx /mild TCP (80–99 × 10 9 /L) (80.0%) groups. Treatment discontinuation due to adverse effects and the development of bacterial infection did not differ between the Spx and non‐ Spx / TCP groups. Conclusion The increase of platelet count after Spx contributed to treatment success, especially for moderate to severe TCP patients who are treatment‐naïve/prior relapse or IL 28 B TT allele.