Novel Drug Can Reduce Transfusions in Thrombocytopenia, CLD

The use of avatrombopag can reduce blood transfusions and rescue procedures prior to scheduled procedures among patients with thrombocytopenia and chronic liver disease (CLD), according to study findings.

“Avatrombopag may provide physicians with a safe and effective alternative to platelet transfusions, simplifying the clinical management of these patients,” the researchers wrote.

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Thrombocytopenia can adversely affect the management of patients with CLD, delaying necessary procedures due to increased risk of bleeding.

“There is a lack of consensus in the field regarding the appropriate target platelet counts in these patients, the bleeding risk of individual procedures, and the variability in the use of prophylactic platelet transfusions,” the researchers wrote.

In the ADAPT-1 trial, the researchers randomly assigned 231 patients to 60 mg avatrombopag (n = 149) or placebo (n = 82). In the ADAPT-2 trial, the researchers randomly assigned 204 patients to 40 mg avatrombopag (n = 128) or placebo (n = 76).

The number of patients who did not require a platelet transfusion or rescue procedure for bleeding after randomization, and up to 7 days after a scheduled procedure, served as the primary endpoint of the ADAPT-1 and -2 trials.

In total, 94% of patients completed each study.

In ADAPT-1, 65.6% of patients who received avatrombopag met the primary endpoint, compared with 22.9% of patients who received placebo. In ADAPT-2, 88.1% of patients who received avatrombopag met the primary endpoint, compared with 38.2% of patients who received placebo.

In both studies, the time until increase in platelet counts after avatrombopag treatment was similar. Avatrombopag increased platelet counts and the number of patients who achieved the target platelet count of a minimum 50 × 109/L on procedure day, compared with patients who received placebo.

Incident rates and severity of adverse events appeared similar between the groups and consistent with what is expected in this patient population.

Common treatment-related adverse events observed between both groups included abdominal pain, dyspepsia, nausea, pyrexia, dizziness, and headache.

—Melinda Stevens

Reference:
Terrault N, Chen YC, Izumi N, et al. Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology. 2018;155(3):705-718. https://doi.org/10.1053/j.gastro.2018.05.025.