FDA Approves Treatment for Thrombocytopenia in Adults with Chronic Liver Disease

The FDA has approved lusutrombopag (Mulpleta) for the treatment of thrombocytopenia in particular adults with chronic liver disease.

The thrombopoietin receptor agonist (TPO RA) therapy, from Shionogi Inc., was approved on Monday for the treatment of low blood-platelet count in adult patients with chronic liver disease who are also scheduled to undergo a medical or dental procedure.

The approval—the second of the TPO RA drug class following the FDA’s nod to Dova Pharmaceutical’s own form of the therapy in May—was based on the results of 2 randomized, double-blind, placebo-controlled trials (L-PLUS 1 and L-PLUS 2)

which involved 300-plus patients with chronic liver disease and severe thrombocytopenia.

In L-PLUS 1, 97 patients with CLD—as defined by platelet counts <50,000 mcL&mdash;who were to undergo invasive procedure were randomized to receive 3 mg lusutrombopag or placebo. Researchers reported that 78% (n= 38) of treated patients did not require platelet transfusion prior to procedure, while just 13% (6) of patients treated with placebo did not require a transfusion.

In L-PLUS 2, 215 patients with CLD were again randomized to receive 3 mg lusutrombopag or placebo for up to 7 days, with invasive procedures performed between Day 9 and 14. Researchers found 64.8% of treated patients required platelet transfusion prior to the procedure, versus just 29% of placebo patients. Adverse events related to bleeding were prevalent in 2.8% of treated patients and 5.6% of placebo patients.

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