Non-cirrhotic thrombocytopenic patients with hepatitis C virus: Characteristics and outcome of antiviral therapy

Background and AimThrombocytopenia is frequently observed in patients with chronic hepatitis C virus (HCV) infection and cirrhosis, although it can also be observed in patients without cirrhosis by a virus-mediated phenomenon. This study assessed the prevalence, characteristics, and outcomes of antiviral therapy in patients with chronic HCV infection and thrombocytopenia not associated with cirrhosis. MethodsThe study included 1268 patients with HCV infection and thrombocytopenia enrolled in the phase 3 ENABLE studies that assessed the impact of eltrombopag on achieving a sustained virologic response to pegylated interferon and ribavirin. The study population was subdivided according to baseline FibroSURE test results into patients with non-cirrhosis (FibroSURE<0.4) and cirrhosis-related (FibroSURE0.75) thrombocytopenia. ResultsCompared with patients with cirrhosis-related thrombocytopenia (n=995; 78.5%), non-cirrhotic patients with thrombocytopenia (n=59; 4.6%) were younger (mean age [95% confidence interval (CI)]: 43.9 [40.7-47.2] vs 52.7 [52.2-53.3] years; P<0.0001), predominantly female (64% [51-76] vs 30% [27-33]; P<0.0001), and less frequently had a Model for End-Stage Liver Disease score 10 (24% [14-37] vs 45% [42-49]; P=0.0012), low albumin levels (35 g/L; 2% [0-9] vs 32% [29-35]; P<0.0001), and prevalence of diabetes mellitus (3% [0-12] vs 21% [19-24]; P=0.0005). The sustained virologic response rate was higher in non-cirrhotic patients with thrombocytopenia (46% [95% CI, 33-59] vs 16% [14-18]; P<0.0001). ConclusionsPatients with thrombocytopenia associated with HCV who have lower FibroSURE test results may have better preserved liver function and higher sustained virologic response rates than patients with cirrhosis.