Terlipressin in the treatment of hepatorenal syndrome

Abstract

Background:Hepatorenal syndrome is a fatal complication of advanced cirrhosis. Terlipressin is the most widely used treatment method, however, the therapy effects remain inconsonant. We aim to systematically assess the safety and efficacy of terlipressin for hepatorenal syndrome.Methods:We conducted a systematic review and meta-analysis. Randomized controlled trials involving terlipressin for hepatorenal syndrome were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate the safety and efficacy of terlipressin for hepatorenal syndrome.Results:A total of 18 randomized controlled trials including 1011 patients were included. Hepatorenal syndrome reverse rate was 42.0% in the terlipressin group and 26.2% in the non-terlipressin group. Terlipressin had greater hepatorenal syndrome reverse rate and renal function improvement rate than placebo and octreotide in the management of HRS. Comparing to norepinephrine, terlipressin had similar efficacy, but with more adverse events. No significant difference of the efficacy was found between terlipressin and dopamine treatment. The subgroup analysis for type 1 HRS had the above same results, except that the adverse events were not significant different between norepinephrine group and terlipressin group.Conclusions:Terlipressin was superior to placebo and octreotide for reversal of hepatorenal syndrome and improving renal function, but it had no superiority comparing to norepinephrine.

Comparison of Hemodynamic Responses to Administration of Vasopressin and Norepinephrine Under General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis

“…Several meta-analyses comparing vasopressin and norepinephrine in critical care units have been reported. [36][37][38] Wang et al administered vasopressin and norepinephrine to patients with hepatorenal syndrome and compared recovery rates from this syndrome. They concluded that the rate of recovery was equivalent for vasopressin and norepinephrine (odds ratio = 1.01, 95% CI: 0.65-1.57, p = 0.96).…”

Frequency of Hepatorenal Syndrome Among Patients With Cirrhosis and Outcome After Treatment

“…Considering the fact that artificial colloid Haemaccel was used instead of albumin, the difference in outcome in terms of full recovery can be justified. The expensive treatment and non-compliant patients with regard to follow-up were the limitations faced during the study [ 24 ].…”

Feasability of Introducing a Thioether Ring in Vasopressin by nisBTC Co-expression in Lactococcus lactis

“…Moreover, since the presence of unusual amino acids such as Dha and the formation of the thioether bond between Dha and Cys in vasopressin could prevent cleavage, an extra Gly was always placed between the engineered cleavage site and the vasopressin sequence. The presence of N-terminal amino acids or other chemical substituents in vasopressin sequence has rendered active molecules such as terlipressin, with three glycines in this position, which is marketed for clinical use (Dobre et al, 2011; Wang et al, 2018). Thus, the presence of glycine or other amino acids at this position is tolerated in terms of activity and enables easier cleavage.…”