Rifaximin treatment for encephalopathy reduces hospital resource use: real-world data don’t fail to IMPRESS

Rifaximin Use, Adherence and Persistence in Patients with Hepatic Encephalopathy: A Real-World Study in the South of Italy

“…In line with other findings, we found a high percentage of recurrence within 60 days after the hospital discharge [ 27 ]. Notably, 25% of our subgroup of patients was readmitted within 21 days and 50% within 60 days from the discharge index, highlighting the need for proper management immediately after an HE episode [ 13 , 14 , 15 , 28 , 29 , 30 ]. Not unexpectedly, we also observed that the mortality rate at 1 year was significantly greater in patients with a hospital readmission post-discharge compared with patients not readmitted during this timeframe (57% vs. 47%, respectively; p < 0.001) (data not shown).…”

“…Another interesting aspect is that rifaximin-α has been shown to act as a eubiotic drug, promoting the growth of beneficial bacterial such as Lactobacilli in cirrhotic patients with HE [ 8 ]. Furthermore, rifaximin-α treatment downregulates the inflammatory response by reducing the expression of proinflammatory cytokines tumour necrosis factor-alpha and interleukin-1, inhibiting the activation of nuclearfactor kappa B and reducing bacterial translocation and virulence without significantly changing the overall composition of the gut microbiota [ 9 , 10 ].The addition of rifaximin to non-absorbable disaccharides has been found to be superior to both treatment with non-absorbable disaccharides or rifaximin alone in terms of having an increased effective rate and decreased mortality in patients with HE [ 11 , 12 , 13 , 14 , 15 ]. In a 24-month open-label maintenance study, rifaximin-α appeared to provide a continued reduction in HE-related and all-cause hospitalization without an increase in adverse events [ 16 ].…”

Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy

“…of AEs and hospitalizations were similar in a 24-month openlabel follow-up study. 19 Additional research indicates that rifaximin may be beneficial in reducing incidence of HE recurrence, [20][21][22][23][24] mortality, 20,21,23,24 and rate of hospitalizations by up to 58%, 21,22 which may translate to a decrease in the health care cost burden attributed to HE.…”

“…[43][44][45] These ■■ Discussion Current guidelines recommend prophylactic treatment following an episode of overt HE to reduce the risk of recurrent HE. 15 Considerable evidence suggests the benefit of long-term prophylactic therapy with rifaximin 1,[19][20][21]23,24,26,38,39 ; however, evidence evaluating the economic effect of rifaximin treatment is lacking. The few published resource utilization studies identified consider the costs associated with HE in general, 25 in the acute inpatient setting, 8 or in diagnostic screening in patients with minimal HE.…”

“…Studies were conducted over a decade apart, during which time significant contributions to the knowledge and understanding of rifaximin treatment for overt HE have been made. [18][19][20]23,24,26,38,42 This economic analysis was able to include data from head-to-head comparison studies of rifaximin ± lactulose, 18 including long-term follow-up data. 19 The Huang et al paper relied on studies of varying duration and design to inform the analysis.…”