Safety and Efficacy of Partial Splenic Embolization in Telaprevir-based Triple Therapy for Chronic Hepatitis C
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- Kondo Chisa
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan
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- Atsukawa Masanori
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan
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- Tsubota Akihito
- Core Research Facilities for Basic Science, Research Center for Medical Sciences, The Jikei University School of Medicine, Japan
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- Shimada Noritomo
- Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Japan
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- Abe Hiroshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine Katsushika Medical Center, Japan
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- Itokawa Norio
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan
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- Nakagawa Ai
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan
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- Fukuda Takeshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Japan
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- Matsushita Yoko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Japan
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- Nakatsuka Katsuhisa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Japan
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- Kawamoto Chiaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Japan
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- Iwakiri Katsuhiko
- Division of Gastroenterology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital, Japan
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- Aizawa Yoshio
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine Katsushika Medical Center, Japan
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- Sakamoto Choitsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Japan
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Objective Pegylated-interferon/ribavirin (peg-IFN/RBV) therapy with a protease inhibitor is the standard therapy for genotype 1b chronic hepatitis C. Despite improving treatment outcomes, patients with thrombocytopenia are often difficult to treat because interferon commonly exacerbates thrombocytopenia. In this study, partial splenic embolization (PSE) was performed in patients with hypersplenism-induced thrombocytopenia to determine the effectiveness of this method as a potential treatment.<br> Methods Patients were pretreated with PSE and then received triple combination therapy. The safety and efficacy of PSE was evaluated.<br> Results Eighteen patients were analyzed, including 12 patients with the interleukin 28B (IL28B) major genotype and 12 patients with the inosine triphosphatase (ITPA) major genotype. The median embolization rate with PSE was 70% (range: 40-85%). PSE increased the patients' platelet counts from 71.5×103 /μL (53-99×103 /μL) to 121.5×103 /μL (70-194×103 /μL; p=0.0002). The patients' platelet counts fluctuated above 50×103 /μL during the treatment. Specifically, the increase in the platelet count was significantly associated with the ITPA major genotype compared with the minor genotype (p=0.0057 at 2 weeks, p=0.0031 at 3 weeks, and p=0.0148 at 4 weeks). Adherence to peg-IFN-α2b was sufficient (1.38 μg/kg/week). The rapid viral response rate was 72.2% (13/18), the end of treatment response rate was 88.9% (16/18), and the sustained virological response (SVR) rate was 66.7% (12/18). The SVR rate for patients with the IL28B major genotype was 83.3% (10/12). No adverse effect due to PSE pretreatment was found in any patients. Furthermore, no patient discontinued treatment due to thrombocytopenia.<br> Conclusion PSE, in conjunction with triple combination therapy, is a useful and safe method to treat genotype 1b chronic hepatitis C patients with hypersplenism-induced thrombocytopenia.<br>
収録刊行物
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- Internal Medicine
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Internal Medicine 54 (2), 119-126, 2015
一般社団法人 日本内科学会