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

Background and Aim: Thrombocytopenia 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. Methods: The 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 (FibroSURE≥0.75) thrombocytopenia. Results: Compared 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). Conclusions: Patients 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.