Pharmacological Therapies for Hepatorenal Syndrome
Autor: | Arjun Nanda, Rewanth Reddy, Ashwani K. Singal, Humaira Safraz, Habeeb Salameh |
---|---|
Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
Hepatorenal Syndrome MEDLINE Octreotide Chronic liver disease 03 medical and health sciences 0302 clinical medicine Pharmacotherapy Hepatorenal syndrome Albumins medicine Humans Vasoconstrictor Agents 030212 general & internal medicine Infusions Intravenous Intensive care medicine Randomized Controlled Trials as Topic business.industry Gastroenterology medicine.disease Midodrine Meta-analysis Drug Therapy Combination 030211 gastroenterology & hepatology Complication business Terlipressin |
Zdroj: | Journal of Clinical Gastroenterology. 52:360-367 |
ISSN: | 0192-0790 |
Popis: | Hepatorenal syndrome (HRS) is a serious complication of advanced chronic liver disease. Different pharmacological therapies have variable efficacy. We performed a systematic review and meta-analysis to compare the efficacy of various drugs in the treatment of HRS.Randomized controlled trials comparing active drug with placebo or comparing 2 different drugs were included in this analysis. Primary study outcome was reversal of HRS. Secondary outcomes were HRS relapse and patient survival. Subgroup analysis was performed on patients with type 1 HRS.Thirteen randomized controlled trial were eligible for analysis. Terlipressin plus albumin was more efficacious than placebo plus albumin (odds ratio=4.72; 95% confidence interval, 1.72-12.93; P=0.003) or midodrine plus albumin and octreotide (odds ratio=5.94; 95% confidence interval, 1.69-20.85; P=0.005), for HRS reversal. However, no significant difference was noted comparing terlipressin plus albumin versus noradrenaline plus albumin, octreotide plus albumin versus placebo plus albumin or noradrenaline plus albumin versus midodrine plus albumin and octreotide. None of the comparisons showed difference on HRS relapse or patient survival. Subgroup analysis revealed that terlipressin was more effective than placebo for type 1 HRS reversal, but no significant differences were noted between any other comparisons, and none of the comparisons showed difference on HRS relapse or patient survival.Intravenous infusion of terlipressin is the most effective medical therapy for reversing HRS. Intravenous infusion of noradrenaline is an acceptable alternative. Studies are needed as basis for developing pharmacological strategies to reduce relapse of HRS and improve patient survival. |
Databáze: | OpenAIRE |
Externí odkaz: |