Document Type
Article
Original Publication Date
2017
Journal/Book/Conference Title
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
Volume
45
Issue
11
First Page
1390
Last Page
1402
DOI of Original Publication
10.1111/apt.14052
Date of Submission
June 2017
Abstract
Background
The goal of hepatorenal syndrome type 1 (HRS-1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS-1, where it is available.
Aim
To compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS-1.
Methods
Pooled patient-level data from two large phase 3, randomised, placebo-controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 μmol/L], 90-day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1–2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days.
Results
The pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between-group difference in SCr concentration of −53.0 μmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin-treated patients.
Conclusions
Terlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS-1. Terlipressin treatment is associated with improved renal function.
Rights
© 2017 The Authors. Alimentary Pharmacology and Therapeutics published by John Wiley & Sons Ltd.
Is Part Of
VCU Internal Medicine Publications
Comments
Originally published at http://doi.org/10.1111/apt.14052