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

Journal: Hepatology Research : The Official Journal Of The Japan Society Of Hepatology

Published: March 06, 2025

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.

Objective: 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.

Authors

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

Relevant Conditions

Thrombocytopenia, Purpura, Blood Clots, Adult Immune Thrombocytopenia, Autoimmune Hepatitis, Immune Thrombocytopenic Purpura (ITP), Hepatitis, Cirrhosis

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

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