Abstract
Thrombocytopenia complicates management of chronic liver disease (CLD), and may interfere with the performance of invasive procedures. Lusutrombopag (LUSU), an oral, small molecule thrombopoietin receptor agonist, has been studied for the treatment of thrombocytopenia in patients with CLD who are scheduled for invasive procedures. Aiming to further assess its efficacy and safety, a meta-analysis of LUSU randomised controlled trial (RCT) data is presented. A direct random-effects meta-analysis was conducted in Stata 14.2MP, using the method of DerSimonian and Laird, with data from three RCTs enrolling pre-procedure CLD patients with a platelet count (PC) < 50 × 10ˆ9/L. Patients were randomised to receive LUSU 3 mg once daily or placebo (PBO) for up to seven days prior to their invasive procedure, with the procedure performed between day 9 and 14. LUSU is statistically significantly better than PBO in reducing the need for platelet transfusions (PT) prior to and after an invasive procedure (No PT during study: Odds ratio 11.24 (95% CI: 2.83, 44.64); p = 0.001). During the procedure window, patients who received LUSU and no PT had a statistically significant higher increase in PC than patients who received PBO and a PT (mean difference between LUSU and no PT versus PBO with PT at day 12: 34.18 × 10ˆ9/L (95% CI: 30.31, 38.06; p < 0.001)). LUSU significantly reduced the rate of any bleeding (irrespective of severity) during the study compared to PBO (OR 0.45 (95% CI: 0.22, 0.93; p = 0.03)). Overall, there was no significant difference between LUSU and PBO in the rate of treatment emergent adverse events (TEAEs), including splanchnic thrombosis. LUSU can safely increase PC in thrombocytopenic CLD patients prior to an invasive procedure, reducing the need for platelet transfusions and lowering the risk of bleeding.
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