Autoimmune hepatitis following transition from prednisolone to thrombopoietin receptor agonist therapy in immune thrombocytopenic purpura: A clinical precaution

IF 3.4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Research Pub Date : 2025-04-18 DOI:10.1111/hepr.14198

Kaname Inarimori, Keisuke Kakisaka, Takuya Watanabe, Tokio Sasaki, Yudai Fujiwara, Tamami Abe, Akiko Suzuki, Kei Endo, Yuichi Yoshida, Akio Miyasaka, Hidekatsu Kuroda, Takayuki Matsumoto

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引用次数: 0

Abstract

Background

Autoimmune hepatitis (AIH) occasionally complicates immune thrombocytopenic purpura (ITP). The risk of AIH development after prednisolone (PSL) discontinuation and thrombopoietin receptor agonist (TPO-RA) initiation remains underrecognized.

Aim and Methods

We report two cases of AIH that developed or exacerbated after switching from PSL to TPO-RAs (avatrombopag and eltrombopag) for ITP treatment.

Results

Case 1 developed AIH 8 months after PSL discontinuation and avatrombopag initiation. Case 2 experienced AIH exacerbation with acute decompensation of liver cirrhosis 2 months after PSL discontinuation while on eltrombopag. Both cases showed no improvement after TPO-RA discontinuation but responded well to PSL reintroduction.

Conclusions

PSL discontinuation likely unmasks underlying AIH in ITP patients, with TPO-RAs potentially modulating immune responses. Regular liver function monitoring is essential when transitioning ITP patients from PSL to TPO-RAs.

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免疫性血小板减少性紫癜由强的松龙转为血小板生成素受体激动剂治疗后的自身免疫性肝炎：临床预防。

背景：自身免疫性肝炎（AIH）偶尔会并发免疫性血小板减少性紫癜（ITP）。泼尼松龙（PSL）停药和启动血小板生成素受体激动剂（TPO-RA）后AIH发展的风险仍未得到充分认识。目的和方法：我们报告了两例AIH在从PSL切换到TPO-RAs治疗ITP后发生或加重的病例（阿伐洛巴格和依曲波巴格）。结果：病例1在停用PSL并开始使用阿伐单帕8个月后发生AIH。病例2在停用PSL 2个月后出现AIH加重，并发急性肝硬化失代偿。两例患者停用TPO-RA后均无改善，但重新引入PSL后反应良好。结论：停用PSL可能揭示ITP患者潜在的AIH， TPO-RAs可能调节免疫反应。当ITP患者从PSL转变为TPO-RAs时，定期监测肝功能是必不可少的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology Research 医学-胃肠肝病学

CiteScore

8.30

自引率

14.30%

发文量

124

审稿时长

1 months

期刊介绍： Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.