Factors Associated with Significant Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients Receiving Direct-Acting Antivirals.
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Chen Yen-Chun, Chang Te-Sheng, Chen Chien-Hung, Cheng Pin-Nan, Lo Ching-Chu, Mo Lein-Ray, Chen Chun-Ting, Huang Chung-Feng, Kuo Hsing-Tao, Huang Yi-Hsiang, Tai Chi-Ming, Peng Cheng-Yuan, Bair Ming-Jong, Yeh Ming-Lun, Lin Chih-Lang, Lin Chun-Yen, Lee Pei-Lun, Chong Lee-Won, Hung Chao-Hung, Huang Jee-Fu, Yang Chi-Chieh, Hu Jui-Ting, Lin Chih-Wen, Wang Chia-Chi, Su Wei-Wen, Hsieh Tsai-Yuan, Lin Chih-Lin, Tsai Wei-Lun, Lee Tzong-Hsi, Chen Guei-Ying, Wang Szu-Jen, Chang Chun-Chao, Yang Sheng-Shun, Wu Wen-Chih, Huang Chia-Sheng, Hsiung Chou-Kwok, Kao Chien-Neng, Tsai Pei-Chien, Liu Chen-Hua, Lee Mei-Hsuan, Dai Chia-Yen, Kao Jia-Horng, Chuang Wan-Long, Lin Han-Chieh, Chen Chi-Yi, Tseng Kuo-Chih, Yu Ming-Lung, On Behalf Of Tacr Investigators
Аннотация
To clarify the predictive factors of significant platelet count improvement in thrombocytopenic chronic hepatitis C (CHC) patients. CHC patients with baseline platelet counts of <150 × 103/μL receiving direct-acting antiviral (DAA) therapy with at least 12-weeks post-treatment follow-up (PTW12) were enrolled. Significant platelet count improvement was defined as a ≥10% increase in platelet counts at PTW12 from baseline. Platelet count evolution at treatment week 4, end-of-treatment, PTW12, and PTW48 was evaluated. This study included 4922 patients. Sustained virologic response after 12 weeks post-treatment was achieved in 98.7% of patients. Platelet counts from baseline, treatment week 4, and end-of-treatment to PTW12 were 108.8 ± 30.2, 121.9 ± 41.1, 123.1 ± 43.0, and 121.1 ± 40.8 × 103/μL, respectively. Overall, 2230 patients (45.3%) showed significant platelet count improvement. Multivariable analysis revealed that age (odds ratio (OR) = 0.99, 95% confidence interval (CI): 0.99-1.00, p = 0.01), diabetes mellitus (DM) (OR = 1.20, 95% CI: 1.06-1.38, p = 0.007), cirrhosis (OR = 0.66, 95% CI: 0.58-0.75, p < 0.0001), baseline platelet counts (OR = 0.99, 95% CI: 0.98-0.99, p < 0.0001), and baseline total bilirubin level (OR = 0.80, 95% CI: 0.71-0.91, p = 0.0003) were independent predictive factors of significant platelet count improvement. Subgroup analyses showed that patients with significant platelet count improvement and sustained virologic responses, regardless of advanced fibrosis, had a significant increase in platelet counts from baseline to treatment week 4, end-of-treatment, PTW12, and PTW48. Young age, presence of DM, absence of cirrhosis, reduced baseline platelet counts, and reduced baseline total bilirubin levels were associated with significant platelet count improvement after DAA therapy in thrombocytopenic CHC patients.