Hepatology research : the official journal of the Japan Society of Hepatology · 2025
Autoimmune hepatitis following transition from prednisolone to thrombopoietin receptor agonist therapy in immune thrombocytopenic purpura: A clinical precaution.
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Inarimori Kaname, Kakisaka Keisuke, Watanabe Takuya, Sasaki Tokio, Fujiwara Yudai, Abe Tamami, Suzuki Akiko, Endo Kei, Yoshida Yuichi, Miyasaka Akio, Kuroda Hidekatsu, Matsumoto Takayuki
Аннотация
BACKGROUND: Autoimmune hepatitis (AIH) occasionally complicates immune thrombocytopenic purpura (ITP). The risk of AIH development after prednisolone (PSL) discontinuation and thrombopoietin receptor agonist (TPO-RA) initiation remains underrecognized.
AIM AND METHODS: We report two cases of AIH that developed or exacerbated after switching from PSL to TPO-RAs (avatrombopag and eltrombopag) for ITP treatment.
RESULTS: Case 1 developed AIH 8 months after PSL discontinuation and avatrombopag initiation. Case 2 experienced AIH exacerbation with acute decompensation of liver cirrhosis 2 months after PSL discontinuation while on eltrombopag. Both cases showed no improvement after TPO-RA discontinuation but responded well to PSL reintroduction.
CONCLUSIONS: PSL discontinuation likely unmasks underlying AIH in ITP patients, with TPO-RAs potentially modulating immune responses. Regular liver function monitoring is essential when transitioning ITP patients from PSL to TPO-RAs.
AIM AND METHODS: We report two cases of AIH that developed or exacerbated after switching from PSL to TPO-RAs (avatrombopag and eltrombopag) for ITP treatment.
RESULTS: Case 1 developed AIH 8 months after PSL discontinuation and avatrombopag initiation. Case 2 experienced AIH exacerbation with acute decompensation of liver cirrhosis 2 months after PSL discontinuation while on eltrombopag. Both cases showed no improvement after TPO-RA discontinuation but responded well to PSL reintroduction.
CONCLUSIONS: PSL discontinuation likely unmasks underlying AIH in ITP patients, with TPO-RAs potentially modulating immune responses. Regular liver function monitoring is essential when transitioning ITP patients from PSL to TPO-RAs.