Abstract
Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.
Highlights
BackgroundDengue is an infectious, arboviral disease of humans transmitted by mosquitoes [1]
Dengue has been proclaimed as a priority infection by World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and World Bank
Worldwide endeavors have been made to develop new management strategies to fight this fatal complication in dengue patients
Summary
Arboviral disease of humans transmitted by mosquitoes [1]. According to the World Health Organization (WHO), dengue is a major public health challenge worldwide, with a higher incidence in tropical and subtropical countries [2]. Eltrombopag is a quite well-tolerated drug with a decent safety and efficacy profile and can be used for the treatment of splenectomized ITP patients (platelet count 100X109/L platelets even after 230 days of romiplostim treatment [27] This interesting finding definitely opens a new therapeutic option for treating thrombocytopenia in dengue. No specific vaccines are available to treat dengue and the mortality rate of DHF/DSS patients is increasing due to the lack of precise treatment In this context, it is extremely important to focus on therapy that would prove effective in the management of thrombocytopenia related to dengue death. We need to tease out those groups of DHF patients who might benefit from the new molecules by conducting large studies
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