Shionogi Announces Results For Lusutrombopag (S-888711) Phase III Study (L-PLUS2) For The Treatment Of Thrombocytopenia In Patients With Chronic Liver Disease Undergoing Elective Invasive Procedures

- Rolling Submission of New Drug Application to FDA Initiated as Part of Fast Track Designation

OSAKA, Japan and FLORHAM PARK, N.J., Sept. 25, 2017 /PRNewswire/ -- Shionogi & Co., Ltd. (hereafter "Shionogi") has announced that lusutrombopag (S-888711), an investigational, once-daily, orally administered, small molecule thrombopoietin (TPO) receptor agonist, demonstrated superiority to placebo and met the primary and all pre-specified important secondary endpoints in a global Phase 3 study (L-PLUS2) to investigate the treatment of thrombocytopenia in patients with chronic liver disease undergoing non-emergent invasive procedures.

Shionogi Inc. Logo (PRNewsFoto/Shionogi Inc.)

L-PLUS2 was a multi-national, double-blind, placebo-controlled study. A total of 215 patients were randomized 1:1 to receive 3 mg of lusutrombopag, or placebo, up to seven days. Therapy was initiated on Day 1 and invasive procedures were performed between Day 9 and Day 14. A pre-procedure platelet transfusion was mandated by the study protocol if a patient's platelet count prior to the invasive procedure had not reached 50,000/µL.

Top-line L-PLUS2 study results include:

  • 64.8 percent of lusutrombopag patients versus 29.0 percent of placebo patients met the primary efficacy endpoint, which was defined as the proportion of patients who required no platelet transfusion prior to the primary invasive procedure and no rescue therapy for bleeding from randomization through seven days following the procedure.
  • 64.8 percent of patients taking lusutrombopag achieved a platelet count of at least 50,000/µL and had an increase in platelet count of at least 20,000/µL from baseline, compared to 13.1 percent of patients taking placebo.
  • Lusutrombopag was generally well tolerated, with adverse events deemed treatment-related by the investigator in 5.6 percent of patients taking lusutrombopag versus 12.1 percent of patients taking placebo.
  • Adverse events related to bleeding occurred in 2.8 percent of patients in the lusutrombopag group versus 5.6 percent of patients in the placebo group. No patients taking lusutrombopag and 1.9 percent of patients taking placebo required rescue therapy for bleeding.
  • Adverse events related to thrombosis were reported in 1.9 percent of patients in each treatment group.

Results from the L-PLUS2 study demonstrated similar efficacy and safety outcomes to those in the previously completed L-PLUS1 study (a similarly designed Phase 3, randomized, double-blind, placebo-controlled study conducted in Japan).

"We are very excited about the efficacy and safety results observed in this second Phase 3 trial of lusutrombopag. Patients with chronic liver disease and thrombocytopenia undergoing non-emergent invasive procedures currently have no approved medical treatment options except for platelet transfusions, therefore therapeutic options in this area are critically needed," said Dr. Tsutae "Den" Nagata, Chief Medical Officer.

Lusutrombopag has been granted Fast Track designation by the Food and Drug Administration (FDA) for the treatment of thrombocytopenia in patients with chronic liver disease who are at increased risk for bleeding associated with elective invasive procedures. Based on the results from the L-PLUS1 and L-PLUS2 Phase 3 studies, Shionogi has initiated rolling submission of a New Drug Application to the FDA. Shionogi plans to present L-PLUS2 study data at future hepatology and hematology conferences later this year.

About Lusutrombopag
Lusutrombopag (S-888711) is an orally administered, small molecule agonist of human thrombopoietin receptor. Lusutrombopag was approved by the Ministry of Health, Labor and Welfare in Japan in September 2015 for the improvement of thrombocytopenia associated with chronic liver disease in patients undergoing an elective invasive procedure.

About Thrombocytopenia
Thrombocytopenia is a common complication of chronic liver disease (CLD), which may be caused by multiple factors including decreased production of thrombopoietin. CLD-associated thrombocytopenia is defined as a platelet count of less than 150,000/µL and is the most common hematologic complication of CLD.1,2,3 Patients with CLD and thrombocytopenia are at increased risk for bleeding, requiring recurrent platelet transfusions, increased ambulatory visits and inpatient hospital stays compared with patients with CLD without thrombocytopenia.4 The annual health care cost of a patient with CLD with hepatitis C virus with thrombocytopenia is more than three times that of a patient with the virus without thrombocytopenia.4 In addition to the potential of thrombocytopenia, especially severe thrombocytopenia (platelet count less than 50,000/µL), to aggravate surgical or traumatic bleeding, it may also significantly complicate routine patient care, such as liver biopsy and medically indicated or elective procedures for cirrhotic patients, resulting in delayed or cancelled medical management.5

About Shionogi
Shionogi & Co., Ltd. is a major research-driven pharmaceutical company dedicated to bringing benefits to patients based on its corporate philosophy of "supplying the best possible medicine to protect the health and wellbeing of the patients we serve." Shionogi's research and development currently target two therapeutic areas: infectious diseases, and pain/CNS disorders. For over 50 years, Shionogi has developed and commercialized innovative oral and parenteral anti-infectives. In addition, Shionogi is engaged in new research areas, such as obesity/geriatric metabolic disease and oncology/immunology. Contributing to the health and quality of life of patients around the world through development in these therapeutic areas is Shionogi's primary goal. For more details, please visit For more information on Shionogi Inc., the U.S.based subsidiary of Shionogi & Co., Ltd., headquartered in Florham Park, NJ, USA, please visit For more information on Shionogi Ltd., the UK-based subsidiary of Shionogi & Co. Ltd., headquartered in London, England, please visit

Forward Looking Statement
This announcement contains forward-looking statements. These statements are based on expectations in light of the information currently available, assumptions that are subject to risks and uncertainties which could cause actual results to differ materially from these statements. Risks and uncertainties include general domestic and international economic conditions such as general industry and market conditions, and changes of interest rate and currency exchange rate. These risks and uncertainties particularly apply with respect to product-related forward-looking statements. Product risks and uncertainties include, but are not limited to, completion and discontinuation of clinical trials; obtaining regulatory approvals; claims and concerns about product safety and efficacy; technological advances; adverse outcome of important litigation; domestic and foreign healthcare reforms and changes of laws and regulations. Also for existing products, there are manufacturing and marketing risks, which include, but are not limited to, inability to build production capacity to meet demand, unavailability of raw materials and entry of competitive products. The company disclaims any intention or obligation to update or revise any forward-looking statements whether as a result of new information, future events or otherwise.



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Koruk M, et al. Hepatogastroenterology. 2002;49:1645-1648.


Aref S, et al. Hematology. 2004;9:351-356.


Gangireddy et al can J Gastroenterol Hepatol 2014.


Hayashi, H et al. World J Gastroenterol 2014 March 14; 20(10): 2595-2605.

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