en hígado y bazo función normal en el bazo. (considerando otras causas morfología anormal de glóbulos rojos). Hipoesplenismo funcional. Etiología irrevesible. mente os sintomas têm contribuído com a boa evolução dos pacientes. Rev. bras . . ram que 1/3 desses pacientes desenvolve hiperesplenismo. Em estudo. hiperesplenismo tratamiento. hiperesplenismo y esplenomegalia pdf. hiperesplenismo pdf causas de hepatoesplenomegalia en adultos.
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Guerra MD and Nydia S. Chang M, et al. Cines DB, et hlperesplenismo. McMillan R, et al. Stasi R, et al. George JN, et al. Kumar M, et al. Elting LS, et al.
Vincristina, ciclosporina, azatioprina, danazol Novas terapias: Receptores agonistas de trombopoetina. Nat Med Cheng et al. N Engl J Med ; Danazol, vincristina, azathioprina, ciclofosfamida, ciclosporina, MMF, etc Gregory Cheng et al. This retrospective analysis demonstrates that success of splenectomy appears se diminish over time.
In patients requiring further ITP treatment, most splenectomized patients who relapse do so within 5 years. The treatment of chronic ITP has advanced as more data on hiperesplfnismo safety and efficacy of new medications like the thrombopoietin receptor agonists have become available. As physicians and patients become more familiar with the risks and benefits of all treatments, options other than splenectomy may be preferred for certain patients.
Patients remain in the study until withdrawal or commercial availability of eltrombopag. N Engl J Med. Vadhan-Raj S, et al.
Wolber E-M, Jelkmann W. Ongoing studies should soon help determine the utility of all these thrombopoietic growth factors in the treatment of thrombocytopenic patients. Blood ; N Engl J Med, The long-term ocular safety of eltrombopag is being assessed in an observational study of patients who have received study medication eltrombopag or placebo in any of the Phase II or III clinical studies. The study initiation date was August and the study is due for completion in The results of this study demonstrate that eltrombopag is capable of activating TPO-specific signal transduction, proliferation and differentiation responses in a manner similar to that of innate TPO.
Reference Erickson-Miller CL, et al. Exp Hematol ; 33 1: Discovery and characterization of a selective, nonpeptidyl thrombopoietin receptor agonist.
Exp Hematol, 33 1: Platelet activation as examined via surface expression of CD62P was also not enhanced by eltrombopag pretreatment as compared to rhTPO.
Exp Hem ; 37 Jenkins JM, et al. Pediatr Blood Cancer ; Kumagai Y, et al. J Supp Oncology ;5 4: Comparative analyses of the small molecule thrombopoietin receptor agonist eltrombopag and thrombopoietin on in vitro platelet function. Exp Hematol, 37 9: The mean increases in platelet count for the 30, 50 and 75 mg dose levels were Fausas consistent increase in platelet count started after 8 days of repeat dosing with eltrombopag, and the time from first dose to peak platelet count was 16 days.
By Day 22 12 days after the last dose of eltrombopagplatelet count had returned to baseline values, as shown in Figure B. Reference Jenkins JM, et al. Phase 1 clinical study of eltrombopag, an oral, nonpeptide thrombopoietin receptor agonist. Patients were randomly assigned to receive the oral Hiperssplenismo agonist eltrombopag 30, 50 or 75 mg once daily or placebo.
The primary endpoint was a platelet count of 50, or more per cubic millimetre on Day Drugs ; 69 5: Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura.
Reference Williams DD, et al. Clin Ther ; 31 4: Effects of food and antacids on the pharmacokinetics of eltrombopag in healthy adult subjects: Clin Ther, 31 4: Drugs ; 69 3: Patients receiving maintenance immunosuppressive regimens, primarily glucocorticoids, were eligible if the dose had been stable for at least 1 month.
The dose had to remain unchanged throughout the study. Other treatments for ITP must have been completed at least 2 weeks before enrolment. Patients with the following conditions were excluded: Women of childbearing age agreed to use contraception throughout the study. Values within the normal range were required for neutrophils, reticulocyte count, creatinine and liver enzymes. Bussel JB, et al. To reduce the risk of thrombocytosis, treatment was discontinued when platelet counts exceededper cubic millimetre.
After the decision was made to stop the study, the final analysis involving data from patients, including 14 patients who enrolled after the interim cut-off date Septemberwas performed.
Secondary endpoints included safety and tolerability, signs of bleeding, serum thrombopoietin level and health-related quality of life. The incidence and severity of bleeding were assessed at every visit using the World Health Organisation WHO bleeding scale grade 0: All patients were assessed weekly for safety, tolerability and efficacy of the treatment during the 6-week treatment period and at 2-week intervals for 6 weeks after hiperespplenismo study medication had been discontinued.
Patients who withdrew prematurely for any other reason were counted as not having had a response, irrespective of the platelet count.
Esplenomegalia – Wikipedia, a enciclopedia libre
Additional supportive analyses were performed with the use of only observed data at Day 43, with no imputations. Seventy-four percent of the patients had previously received two or more treatments for ITP. Only 20 of the patients had received therapy for ITP other than glucocorticoids or intravenous immunoglobulins within the 3 months preceding the start of the protocol treatment, and these 20 patients were equally distributed among the four treatment groups.
Significant differences in median age and race white vs non-white were observed between treatment groups at baseline. The number of patients experiencing grade 3 or 4 adverse events during the study, or within 30 days after discontinuation of the cusas treatment, was also similar across all four study groups.
A single case of cataract progression was reported days after the last dose of study medication in a year-old woman with a history of glucocorticoid use and cigarette smoking who received 75 mg of eltrombopag daily for 8 days. The event was assessed by the investigator as not related to the ccausas drug.
In the group receiving 30 mg of eltrombopag, one patient each had pain in hipereslenismo legs and pneumonitis.
In the group receiving 50 mg of hioeresplenismo, one patient each had a rectal hemorrhage, herpes zoster, and thrombocytopenia, and one patient had pneumonia, hepatitis, renal failure, and chronic obstructive pulmonary disease. In the group receiving75 mg of eltrombopag, one patient each had trigger finger, menorrhagia, and rash.
Two patients in the eltrombopag 50mg arm experienced a fatal severe adverse event related to study hiperesplrnismo.
Reference GSK Clinical study register. Available at Last accessed Septermber Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: Patients were randomly assigned 2: All patients were assessed for safety, tolerability and efficacy every week during treatment, and at 1, 2, 4 and 6 weeks after cajsas of study drug.
Reference Bussel JB, et al. Lancet ; Revolade drEuropean Summary of Product Characteristics draft. Patients who discontinued treatment for any other reason e. Eligible patients were required to have at least a 6-month history of ITP and have received at least one previous treatment of ITP. Previous treatments with immunoglobulins, immunomodulators, rituximab and cyclophosphamide must have been completed at least 2 weeks prior to enrolment into the study.
It should be noted that patients on placebo were also receiving stable ITP medication. One patient in the placebo arm included in this analysis received intravenous immunoglobulin. The mean percentage change from baseline in platelet counts for patients given eltrombopag was double that of those given placebo at Day 8 and several fold higher throughout the remainder of the treatment period. After completion of treatment, hiperesppenismo counts returned to normal. Note that four patients in the eltrombopag arm and two in the placebo arm were still receiving study medication on or within 3 days before the assessment on Day 50 1 week follow up and were included in this analysis.
Bleeding was assessed using the World Health Organization WHO bleeding scale grade 0, no bleeding; grade 1, petechiae; grade 2, mild blood loss; grade 3, gross blood loss; and grade 4, debilitating blood loss. Significantly fewer patients in the eltrombopag group than in the placebo group had bleeding symptoms, as measured by the WHO bleeding scale, at Day After discontinuation of eltrombopag, when the platelet counts returned to normal, the percentage of patients with any bleeding WHO grades 1—4 increased compared with that recorded during treatment.
One patient in hipereesplenismo placebo arm experienced a serious adverse event, reporting non-fatal gastrointestinal haemorrhage, cerebral heamorrhage and haematuria. There were no serious adverse events reported for patients in the eltrombopag arm.