Durability of Rifaximin Response in Hepatic Encephalopathy

Neff, Guy; Jones, Michael; Broda, Taylor; Jonas, Mark E.; Ravinuthala, Ravi; Novick, David M.; Kaiser, Tiffany E.; Kemmer, Nyingi

doi:10.1097/mcg.0b013e318231faae

Cited by 24 publications

(17 citation statements)

References 19 publications

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“…This study showed reduction in venous ammonia and improvement in health-related quality of life in patients randomized to rifaximin 7, 35 . Additionally a recent study by Neff et al, showed that rifaximin used for greater than 6 months to be an effective agent for HE, particularly in patients with a model for end-stage liver disease (MELD) score less than 20 36 .…”

Section: Antibiotic Use In Covert and Overt Hementioning

confidence: 99%

Antibiotics for the treatment of hepatic encephalopathy

Patidar

Bajaj

2013

Metab Brain Dis

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The treatment of hepatic encephalopathy (HE) is complex and therapeutic regimens vary according to the acuity of presentation and the goals of therapy. Most treatments for HE rely on manipulating the intestinal milieu and therefore antibiotics that act on the gut form a key treatment strategy. Prominent antibiotics studied in HE are neomycin, metronidazole, vancomycin and rifaximin. For the management of the acute episode, all antibiotics have been tested. However the limited numbers studied, adverse effects (neomycin oto- and nephrotoxicity, metronidazole neurotoxicity) and potential for resistance emergence (vancomycin-resistant enterococcus) has limited the use of most antibiotics, apart from rifaximin which has the greatest evidence base. Rifaximin has also demonstrated, in conjunction with lactulose, to prevent overt HE recurrence in a multi-center, randomized trial. Despite its cost in the US, rifaximin may prove cost-saving by preventing hospitalizations for overt HE. In minimal/covert HE, rifaximin is the only systematically studied antibiotic. Rifaximin showed improvement in cognition, inflammation, quality-of-life and driving simulator performance but cost-analysis does not favor its use at the current time. Antibiotics, especially rifaximin, have a definite role in the management across the spectrum of HE.

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Section: Antibiotic Use In Covert and Overt Hementioning

confidence: 99%

Antibiotics for the treatment of hepatic encephalopathy

Patidar

Bajaj

2013

Metab Brain Dis

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“…Impaired mental status, as defined by the Conn score, with higher scores indicating more severe impairment, and impaired neuromotor function includes hyperreflexia, rigidity, myoclonus, and asterixi [9, 10]. Minimal hepatic encephalopathy (MHE) that may has no clinical manifestations could be detected only by neuropsychological methods include portosystemic encephalopathy (PSE) syndrome test, Psychometric-Hepatic-Encephalopathy-Sum- (PHES-) Score [11].…”

Section: Introductionmentioning

confidence: 99%

Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta-Analysis

Lü

et al. 2013

Gastroenterology Research and Practice

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Background. Many studies have found that the antibiotic rifaximin is effective for the treatment of hepatic encephalopathy. However, there is no uniform view on the efficacy and safety of rifaximin. Methods. We performed a meta-analysis through electronic searches to evaluate the efficacy and safety of rifaximin in comparison with nonabsorbable disaccharides. Results. A total of 8 randomized controlled trials including 407 patients were included. The efficacy of rifaximin was equivalent to nonabsorbable disaccharides according to the statistical data (risk ratio (RR): 1.06, 95% CI: 0.94–1.19; P = 0.34). Analysis showed that patients treated with rifaximin had better results in serum ammonia levels (weighted mean difference (WMD): −10.63, 95% CI: −30.63–9.38; P = 0.30), mental status (WMD: −0.32, 95% CI: −0.67–0.03; P = 0.07), asterixis (WMD: −0.12, 95% CI: −0.31–0.08; P = 0.23), electroencephalogram response (WMD: −0.21, 95% CI: −0.34–−0.09; P = 0.0007), and grades of portosystemic encephalopathy (WMD: −2.30, 95% CI: −2.78–−1.82; P < 0.00001), but only the last ones had statistical significance. The safety of rifaximin was better than nonabsorbable disaccharides (RR: 0.19, 95% CI: 0.10–0.34; P < 0.00001). Conclusion. Rifaximin is at least as effective as nonabsorbable disaccharides, maybe better for the treatment of hepatic encephalopathy. And the safety of rifaximin is better.

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“…A prospective study of 78 patients recovering from HE found that rifaximin is superior to lactulose in reducing HE-related hospitalization, but that lactulose was equally effective in preventing new episodes of HE 40. Reduced hospitalization rates and decreased recurrence of HE were also found in four retrospective analyses comprising a total of 452 patients on maintenance therapy 2,46,47,49…”

Section: Clinical Efficacy Of Rifaximinmentioning

confidence: 61%

Safety, efficacy, and patient acceptability of rifaximin for hepatic encephalopathy

Kimer¹,

Krag²,

Gluud³

2014

PPA

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Hepatic encephalopathy is a complex disease entity ranging from mild cognitive dysfunction to deep coma. Traditionally, treatment has focused on a reduction of ammonia through a reduced production, absorption, or clearance. Rifaximin is a nonabsorbable antibiotic, which reduces the production of ammonia by gut bacteria and, to some extent, other toxic derivatives from the gut. Clinical trials show that these effects improve episodes of hepatic encephalopathy. A large randomized trial found that rifaximin prevents recurrent episodes of hepatic encephalopathy. Most patients were treated concurrently with lactulose. Trials have varied greatly in design, outcomes, and duration of treatment regimes. Although a number of retrospective studies have indicated that long-term treatment with rifaximin is safe and possibly beneficial, high quality trials are needed to further clarify efficacy and safety of long-term treatment with rifaximin and evaluate effects of combination therapy with lactulose and branched-chain amino acids for patients with liver cirrhosis and hepatic encephalopathy.

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Durability of Rifaximin Response in Hepatic Encephalopathy

Abstract: Rifaximin is effective for the management of HE in patients with cirrhosis, particularly in populations with MELD scores ≤20. Additional studies are needed to investigate the potential association between MELD scores and the efficacy of HE treatments.

Cited by 24 publications

References 19 publications

Antibiotics for the treatment of hepatic encephalopathy

Antibiotics for the treatment of hepatic encephalopathy

Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta-Analysis

Safety, efficacy, and patient acceptability of rifaximin for hepatic encephalopathy

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