On July 31, 2018, the U.S. Food and Drug Administration (FDA) approved lusutrombopag (Mulpleta, Shionogi Inc.) for thrombocytopenia in adults with chronic liver disease who are scheduled to undergo a medical or dental procedure.
Approval was based on two randomized, double-blind, placebo-controlled trials (L-PLUS 1 and L-PLUS 2, NCT02389621) involving 312 patients with chronic liver disease and severe thrombocytopenia who were undergoing an invasive procedure and had a platelet count less than 50 x 109/L. Patients were randomized 1:1 to receive 3 mg of lusutrombopag or placebo once daily for up to seven days.
In L-PLUS 1, 78% of patients (38 out of 49) receiving lusutrombopag required no platelet transfusion prior to the primary invasive procedure, compared with 13% (6 out of 48) who received placebo (95% CI for treatment difference = 49%, 79%; p < 0.0001). In L-PLUS 2, 65% (70 out of 108) of patients who received lusutrombopag required no platelet transfusion prior to the primary invasive procedure or rescue therapy for bleeding from randomization through seven days after the procedure, compared with 29% (31/107) receiving placebo (95% CI for treatment difference = 25%, 49%; p < 0.0001).
The most common adverse reaction in at least 3% of patients was headache.
The recommended lusutrombopag dosage is 3 mg orally once daily with or without food for seven days.
FDA granted the application priority review and fast track designation. A description of FDA expedited programs is in the Guidance for Industry: Expedited Programs for Serious Conditions—Drugs and Biologics.
Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System or by calling 800-FDA-1088.
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