The treatment of vasopressin V2-receptor antagonists in cirrhosis patients with ascites: a meta-analysis of randomized controlled trials

Abstract

BackgroundAscites is the most common complication of cirrhosis. It may lead to the consequence of poor prognosis and the deterioration of quality of life. Asopressin V2 receptor antagonists is a kind of vaptans, and it has been proved to be effective in hyponatremia patients. We conducted a meta-analysis about treatment of vaptans in cirrhosis patients with ascites.MethodsFollowing our selection criteria, we collected a total of 14 studies containing 16 randomized controlled trials (2620 patients) from a series of database about the treatment with vaptans for cirrhosis with ascites patients. The included studies compared the treatment effect of lixivaptan (VPA 985), or RMJ-351647, or satavaptan, or tolvaptan with placebo.ResultsThe included vaptans (asopressin V2 receptor antagonists) showed significant effect of increasing the serum sodium concentration for cirrhosis patients (WMD = 2.11 mmol/L, p < 0.00001). Patients also could acquire significant improvement of ascites, as this kind of aquaretics can significantly reduce ascites patients’ weight (WMD = −1.53, p < 0.00001), abdominal girth (WMD = −2.04, p < 0.00001), and the ratio of worsening ascites (RR = 0.51, p = 0.001). Though the drug did not produce more total adverse events (RR = 1.04, p = 0.09) and the total serious events (RR = 1.04, p = 0.42), the emergence of excessive correction of serum sodium concentrations (>145 mmol/L) was more frequently noted in patients under the employment of vaptans (RR = 2.14, 95 % CI [1.45, 3.16], p = 0.0001). Whether with the administration of vaptans for short-term or long-term, no survival benefit was detected from the selected studies.ConclusionsAsopressin V2 receptor antagonists could play an effective and safe role in symptomatic treatment for cirrhosis patients with ascites, especially for refractory ascites patients who presented insufficient response to conventional diuretics.

Survival Benefit of Tolvaptan for Refractory Ascites in Patients with Advanced Cirrhosis

“…In contrast, a previous meta-analysis found that tolvaptan treatment did not have survival benefits [10]. A retrospective study showed that longer survival was found in patients responding to tolvaptan therapy [16].…”

“…The vasopressin V2 receptor antagonist, tolvaptan, which was developed in Japan, was shown effective in 50–60% of cirrhotic patients with ascites refractory to conventional diuretics [7-9]. A meta-analysis also found that vasopressin V2 receptor antagonists improved hyponatremia and may improve symptoms in cirrhosis patients with refractory ascites [10]. …”

Evaluation of Spironolactone in Combination with Furosemide in Cirrhotic Patients with Permagna (Large) Ascites

“…Pada sirosis hati dengan ascites permagna, pengukuran lingkar perut merupakan variabel yang harus dilakukan untuk memonitor efek diuretik. 16,17 Pengukuran lingkar perut bersifat subject to error karena bergantung pada posisi pasien dan lokasi pengukuran pada abdomen.…”

Cirrhosis and Renal Dysfunction

“…Günümüzde, sadece tolvaptan ve conivaptan onay almıştır. Maliyetleri yüksektir, bu nedenle düşük ücretli diüretik gibi ilaçlarla karşılaştırıldığında klinik kullanımları sınırlıdır (32).…”

“…Güvenilir, iyi tolere edilebilir ve oral kullanımı sayesinde güvenli bir şekilde ayaktan hastaya başlanabilir, ancak daha çok çalışmaya ihtiyaç vardır. Sonuç olarak, şimdiki veriler ışığında siroz tedavisinde vaptanların rutin kullanımını önerilmiyor (32).…”