Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis

Best, Lawrence; Freeman, Suzanne C.; Sutton, Alex J.; Cooper, Nicola J.; Tng, Eng Loon; Csenar, Mario; Hawkins, Neil; Pavlov, Chavdar S; Davidson, Brian R; Thorburn, Douglas; Cowlin, Maxine; Milne, EJ; Tsochatzis, Emmanuel; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd013103.pub2

Cited by 42 publications

(27 citation statements)

References 106 publications

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“…Similarly, V could be used but close monitoring of adverse events. We believe that T-V could be a good option for cirrhotic patients with AVB and other complications as a hepatorenal syndrome or hypotension [44], but further studies are needed.…”

Section: The Certainty Of Evidence and Implications For Clinical Pracmentioning

confidence: 99%

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Huaringa-Marcelo

Huaman

Brañez-Condorena

et al. 2021

JGLD

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Background and Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I 2 =57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.

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Section: The Certainty Of Evidence and Implications For Clinical Pracmentioning

confidence: 99%

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Huaringa-Marcelo

Huaman

Brañez-Condorena

et al. 2021

JGLD

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“…However, in a recent network meta‐analysis of 25 RCTs and 1263 participants of cirrhosis with HRS comparing 12 different interventions concluded that noradrenaline plus albumin should be compared with terlipressin plus albumin in future trials. The analysis suggested a lower number of adverse events with noradrenaline 42 . However, noradrenaline has a half‐life of 1‐2 minutes, and noradrenaline infusion requires central line insertion and regular intensive care monitoring, which is a significant disadvantage 43 .…”

Section: Evidence For the Role Of Terlipressin In Liver Diseasementioning

confidence: 99%

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Kulkarni

Arab

Premkumar

et al. 2020

Liver International

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Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice‐changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as “terlipressin,” “hepatorenal syndrome,” “varices, esophagal and gastric,” “ascites” and “cirrhosis.” Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute‐on‐chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis‐induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.

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“…Several notable studies have evaluated the mortality benefit of albumin and vasoconstrictor in HRS-AKI with conflicting results[ 43 - 45 , 47 - 53 ]. Based on two of the recent meta-analyses, there is no conclusive survival benefit of albumin and vasoconstrictor infusion in HRS-AKI when compared to placebo[ 54 , 55 ].…”

Section: Established Indication Of Albumin In Decompensated Cirrhosismentioning

confidence: 99%

Long-term albumin infusion in decompensated cirrhosis: A review of current literature

Wong

Kumar

Chua³

2021

WJH

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Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction. Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis, large-volume paracentesis and hepatorenal syndrome. Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients. We review the current literature on both the established and potential role of albumin, and specifically address the controversies of long-term albumin infusion in decompensated cirrhosis patients.

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Treatment for hepatorenal syndrome in people with decompensated liver cirrhosis: a network meta-analysis

Cited by 42 publications

References 106 publications

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives

Long-term albumin infusion in decompensated cirrhosis: A review of current literature

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