Within the class of thrombopoietin receptor agonists (TPO-RAs), avatrombopag maleate demonstrates several distinct advantages that solidify its position in clinical practice.

1. Superior Profile Designed for Liver Disease Patients

(1) No Dose Adjustment for Hepatic Impairment: Unlike first-generation TPO-RAs (e.g., eltrombopag), avatrombopag is not metabolized by the hepatic cytochrome P450 system. This means no dose adjustment is required for patients with chronic liver disease, simplifying administration and enhancing safety.

(2) No Dietary Restrictions: Its absorption is not significantly affected by calcium or polyvalent cations in food. Patients can take it without fasting or avoiding specific foods, greatly improving adherence.

(3) Predictable Efficacy: Its platelet-elevating effect is independent of endogenous TPO levels, ensuring reliable efficacy even in liver disease patients who may have elevated TPO.

2. Excellent Clinical and Treatment Experience

(1) Oral Convenience: As an oral formulation, it offers a superior treatment experience compared to subcutaneous injections (e.g., romiplostim), especially for ITP patients requiring long-term management, as it eliminates the need for clinic visits or self-injection.

(2) Short, Defined Course: For peri-procedural use, the standard course is only 5 days (days 10 to 5 before the procedure), offering a clear and manageable treatment burden.

(3) Favorable Safety Profile: Clinical trial data indicates a relatively lower risk of hepatotoxicity and thrombosis compared to some alternatives, contributing to a positive benefit-risk profile.

3. Positioning vs. Domestic Innovative Counterparts

Compared to newer domestic TPO-RAs (e.g., hetrombopag), avatrombopag's strengths include:

(1) Earlier Global Approval and Data: Backed by global Phase III clinical trial data, it holds a well-established position in international treatment guidelines.

(2) Clear CLD Indication: It has more extensive clinical research and application experience specifically in the niche area of chronic liver disease-associated thrombocytopenia.