Response criteria of tolvaptan for the treatment of hepatic edema

Hiramine, Yasunari; Uojima, Haruki; Nakanishi, Hiroyuki; Hiramatsu, Akira; Iwamoto, Takuya; Kimura, Mutsuumi; Kawaratani, Hideto; Terai, Shuji; Yoshiji, Hitoshi; Uto, Hirofumi; Sakaida, Isao; Izumi, Namiki; Okita, Kiwamu; Koike, Kazuhiko

doi:10.1007/s00535-017-1366-6

Cited by 32 publications

(41 citation statements)

References 44 publications

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“…Tolvaptan administration was initiated at a dose of 3.75 mg in all patients, but the response was judged not effective; the dosage was increased to 7.5 mg after few days. A validation study on the changes in bodyweight with improvement of symptoms has recently been performed, and 1.5 kg/week weight loss was reported . Based on the definition of a responder as a patient with weight loss ≥ 1.5 kg within 1 week, 57 patients were initial non‐responders.…”

Section: Methodsmentioning

confidence: 99%

“…A validation study on the changes in bodyweight with improvement of symptoms has recently been performed, and 1.5 kg/week weight loss was reported. 8 Based on the definition of a responder as a patient with weight loss ≥ 1.5 kg within 1 week, 57 patients were initial non-responders. After excluding those who died during hospitalization, those treated with puncture drainage of ascites, and those with discontinuation of tolvaptan administration (for economic reasons), 45 non-responders were included in the study.…”

Section: Methodsmentioning

confidence: 99%

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Analysis of tolvaptan non‐responders and outcomes of tolvaptan treatment of ascites

Iwamoto

Maeda

Saeki

et al. 2018

J of Gastro and Hepatol

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Background and Aim The goals of the study were to identify an effective treatment for ascites and to examine the influence of tolvaptan on outcomes by investigating non‐responders to tolvaptan and comparing outcomes of hepatic cirrhosis in patients treated with and without tolvaptan. Methods In Study 1, of 145 patients with hepatic cirrhosis who were treated with tolvaptan between September 2013 and March 2018, 45 who did not achieve weight loss of ≥1.5 kg within one week were investigated. In Study 2, 83 patients who received tolvaptan for ascites between September 2013 and March 2017 were compared with 131 patients who were treated for ascites without use of tolvaptan between January 2006 and January 2012. Results In Study 1, the 45 patients were divided into three groups based on changes in dosing of diuretics. Renal function was retained in the dose reduction group compared with that in the other groups, and the rate of discharge with remission and the outcomes were also favorable in patients with dose reduction. In Study 2, survival was significantly more favorable in patients treated with tolvaptan. Conclusions Dose reduction of diuretics may be effective for patients with reduced renal function for whom tolvaptan is ineffective or the effect is insufficient and may also improve outcomes of patients with hepatic cirrhosis by preventing a decline in renal function caused by an increased dose of diuretics.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Analysis of tolvaptan non‐responders and outcomes of tolvaptan treatment of ascites

Iwamoto

Maeda

Saeki

et al. 2018

J of Gastro and Hepatol

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“…In the tolvaptan group, tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan [10].…”

Section: Methodsmentioning

confidence: 99%

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

Kida¹

2019

Dig Dis

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Aims: Ascites is one of the major complications in advanced cirrhotic patients. Tolvaptan is a non-peptide orally available arginine vasopressin V2 receptor antagonist. We investigated and found that tolvaptan therapy improved the prognosis and predictive factor of cirrhotic patients with ascites. Methods: Overall, 99 patients with newly diagnosed ascites with cirrhosis were enrolled. No patients had intrahepatic malignancy. The patients were divided into 2 groups based on tolvaptan therapy: 86 patients treated with tolvaptan (tolvaptan-group) and 13 patients treated without tolvaptan (non-tolvaptan-group). Tolvaptan-responder was defined as body weight loss of ≥1.5 kg/week after administering tolvaptan. Results: Tolvaptan therapy was effective in 61.6% of cirrhotic patients. There was a significant difference in the overall survival (OS) between the tolvaptan-responder-group and the other groups (p < 0.001). Male (HR 5.05; p = 0.01), tolvaptan responder (HR 0.21; p = 0.02), and dosage of furosemide < 40 mg/day (HR 0.17; p = 0.01) were factors that were independently associated with the OS. The multivariate analysis revealed that C-reactive protein < 0.9 mg/dL (HR 0.07; p = 0.001), and furosemide dosage < 40 mg/day (HR 0.09; p = 0.003) were independently associated with the tolvaptan response. Conclusion: Therapeutic response to tolvaptan was associated with longer survival in cirrhosis patients complicated with ascites. These preliminary findings warrant validation and further exploration.

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“…A patient was defined as a responder when the score decreased by 1 point or more after Tolvaptan administration. Furthermore, the efficacy rate of Tolvaptan on a decrease in the body weight of more than 1.5 kg [9] was evaluated.…”

Section: Methodsmentioning

confidence: 99%

The Evaluation of Tolvaptan Therapy and Long-Term Prognosis in Hepatocellular Carcinoma with Refractory Ascites

Shimada¹,

Iwase²,

Hirashima³

et al. 2018

OJGas

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We investigated Tolvaptan efficacy and long-term prognosis with focus on nutrition in 20 patients with refractory hepatic ascites in hepatocellular carcinoma (HCC). Bloating improved in 55% of patients, as determined using a Japanese version of the Support Team Assessment Schedule. Nutritional status improved with Tolvaptan treatment, based on the Controlling Nutritional Status score and Onodera's prognostic nutritional index. Long-term prognosis was better in responders than in non-responders (mean survival time: 308 days vs. 97 days, p = 0.031). Tolvaptan was even effective in many patients with HCC, with additional improvement in long-term prognosis expected with improvement in the nutritional status.

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Response criteria of tolvaptan for the treatment of hepatic edema

Abstract: The cutoff value of body weight change that most accurately reflected symptom reduction was 1.5 kg/week; this value is expected to be an effective indicator of response to tolvaptan in clinical practice.

Cited by 32 publications

References 44 publications

Analysis of tolvaptan non‐responders and outcomes of tolvaptan treatment of ascites

Analysis of tolvaptan non‐responders and outcomes of tolvaptan treatment of ascites

Positive Response to Tolvaptan Treatment Would Be a Good Prognostic Factor for Cirrhotic Patients with Ascites

The Evaluation of Tolvaptan Therapy and Long-Term Prognosis in Hepatocellular Carcinoma with Refractory Ascites

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