Carvedilol tied to improved survival in cirrhosis patients: Study
UK: Carvedilol improves survival in patients with cirrhosis and portal hypertension, suggests a recent study in the journal Alimentary Pharmacology & Therapeutics.
The standard of care in patients with cirrhosis and portal hypertension is primary prophylaxis of variceal haemorrhage with non‐selective beta blockers (NSBB) or variceal band ligation (VBL). NSBB, carvedilol in particular, may offer survival benefit. Considering this, Hannah R. McDowell, Royal Infirmary of Edinburgh, Edinburgh, UK, and colleagues aimed to assess mortality in a cohort of patients previously randomized to either carvedilol or VBL.
For the purpose, the researchers retrospectively analysed 152 patients (77 received carvedilol and 75 received VBL) recruited to a multi‐centre randomised controlled trial between 7 April 2000 and 24 June 2006. The trial was designed to assess the efficacy of VBL versus carvedilol in preventing first variceal bleed. Electronic records were used to undertake long‐term follow‐up (up to 20 years).
The primary outcome was all‐cause mortality and secondary end points were liver‐related mortality and decompensation events (ascites, encephalopathy, variceal bleeding).
Key findings of the study include:
- In the intention‐to‐treat analysis, carvedilol offered a significant survival advantage with median survival of 7.8 years compared to 4.2 years in the VBL group.
- This survival benefit was maintained in per‐protocol analysis when patients who crossed between treatment arms were excluded.
- Transplant‐free survival, liver‐related mortality and decompensation events were similar in both groups.
"Our findings suggest that carvedilol offers a significant survival benefit for patients with cirrhosis and portal hypertension," wrote the authors.
"The difference in all‐cause and liver‐related mortality suggests that this survival benefit may not be entirely liver‐related. Prospective, studies are required to confirm these important findings," they concluded.
"Carvedilol is associated with improved survival in patients with cirrhosis: a long‐term follow‐up study," is published in the journal Alimentary Pharmacology & Therapeutics.