Vasoactive treatments effective in patients with hepatorenal syndrome, study finds
Canada: Hepatorenal syndrome (HRS) is known to be associated with high rates of morbidity and mortality. A recent study published in Critical Care Medicine has found that a vasoactive drug terlipressin increases the reversal of hepatorenal syndrome compared to a placebo and may reduce mortality.
The study further states, "until the improvement in terlipressin access, initial norepinephrine administration may be more suitable than an initial trial with midodrine+octreotide. The review holds the potential to inform future guidelines and practices in HRS treatment."
Considering the uncertain evidence examining commonly used drug treatments, Tyler Pitre, Department of Internal Medicine, McMaster University, Hamilton, ON, Canada, and colleagues aimed to assess the comparative effectiveness of inpatient treatments for HRS by performing a network meta-analysis of randomized clinical trials (RCTs).
For this purpose, the researchers searched the online databases to identify eligible RCTs that enrolled patients with type 1 or 2 HRS. Data were extracted by pairs of reviewers.
The researchers assessed the risk of bias using the Cochrane tool for RCTs and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The main outcomes were HRS reversal, all-cause mortality, and serious adverse events. 26 RCTs examining 1,736 patients were included out of 3,079 citations.
Based on the study, the researchers found the following:
- Based on the pooled analysis, terlipressin increases HRS reversal compared with placebo (142 reversals per 1,000 high certainty).
- Norepinephrine (112.7 reversals per 1,000) may increase HRS reversal compared with placebo (low certainty).
- The effect of midodrine+octreotide (67.8 reversals per 1,000; very low) on HRS reversal is uncertain.
- Terlipressin may reduce mortality compared with placebo (93.7 fewer deaths; low certainty).
- Terlipressin probably increases the risk of serious adverse events compared with placebo (20.4 more events per 1,000; moderate certainty).
The researchers conclude, "Our review has the potential to inform future guidelines and practice in the treatment of HRS."
Reference:
Pitre, Tyler MD1; Kiflen, Michel MSc2,3; Helmeczi, Wryan MD4; Dionne, Joanna C. PhD5,6; Rewa, Oleksa MD7; Bagshaw, Sean M. MD7; Needham-Nethercott, Natalie MD8,9; Alhazzani, Waleed MD5,6; Zeraatkar, Dena PhD6,10; Rochwerg, Bram MD5,6. The Comparative Effectiveness of Vasoactive Treatments for Hepatorenal Syndrome: A Systematic Review and Network Meta-Analysis. Critical Care Medicine: July 01, 2022 - Volume - Issue - 10.1097/CCM.0000000000005595 doi: 10.1097/CCM.0000000000005595
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