BACKGROUND: Hepatorenal syndrome (HRS) is a common complication in patients with cirrhosis or fulminant liver failure. We systematically reviewed the benefits and harms of using terlipressin, a novel vasoconstricting agent in patients with HRS. METHODS: We searched MEDLINE, SCOPUS, and conference proceedings for relevant trials of terlipressin. Results were summarized using the random-effects model. RESULTS: Eight trials (320 participants) were included. When compared with placebo, terlipressin-treated patients had higher HRS reversal (odds ratio [OR] 7.47, 95% confidence interval [CI] 3.17-17.59), mean arterial pressure (weighted mean difference [WMD] 11.26 mmHg, 95% CI 1.52-21), and urine output. There was a significant increase in ischemic adverse events with terlipressin when compared to placebo. There was mild-to-moderate heterogeneity in these analyses. There was no significant difference between terlipressin and noradrenaline in HRS reversal (OR 1.23, 95% CI, 0.43-3.54), mean arterial pressure, and urine output. Side-effect profile did not differ between terlipressin and noradrenaline. CONCLUSION: Terlipressin improves HRS reversal and other surrogate outcome measures compared with placebo, but no significant differences for these outcomes were noted when comparing terlipressin and noradrenaline. Terlipressin is a potential therapeutic option for HRS, but larger trials comparing terlipressin to other widely used vasoconstrictors are warranted.
BACKGROUND:Hepatorenal syndrome (HRS) is a common complication in patients with cirrhosis or fulminant liver failure. We systematically reviewed the benefits and harms of using terlipressin, a novel vasoconstricting agent in patients with HRS. METHODS: We searched MEDLINE, SCOPUS, and conference proceedings for relevant trials of terlipressin. Results were summarized using the random-effects model. RESULTS: Eight trials (320 participants) were included. When compared with placebo, terlipressin-treated patients had higher HRS reversal (odds ratio [OR] 7.47, 95% confidence interval [CI] 3.17-17.59), mean arterial pressure (weighted mean difference [WMD] 11.26 mmHg, 95% CI 1.52-21), and urine output. There was a significant increase in ischemic adverse events with terlipressin when compared to placebo. There was mild-to-moderate heterogeneity in these analyses. There was no significant difference between terlipressin and noradrenaline in HRS reversal (OR 1.23, 95% CI, 0.43-3.54), mean arterial pressure, and urine output. Side-effect profile did not differ between terlipressin and noradrenaline. CONCLUSION: Terlipressin improves HRS reversal and other surrogate outcome measures compared with placebo, but no significant differences for these outcomes were noted when comparing terlipressin and noradrenaline. Terlipressin is a potential therapeutic option for HRS, but larger trials comparing terlipressin to other widely used vasoconstrictors are warranted.
Authors: Tea Restuccia; Rolando Ortega; Monica Guevara; Pere Ginès; Carlo Alessandria; Osman Ozdogan; Miquel Navasa; Antoni Rimola; Juan Carlos Garcia-Valdecasas; Vicente Arroyo; Juan Rodés Journal: J Hepatol Date: 2004-01 Impact factor: 25.083
Authors: A Ginès; A Escorsell; P Ginès; J Saló; W Jiménez; L Inglada; M Navasa; J Clària; A Rimola; V Arroyo Journal: Gastroenterology Date: 1993-07 Impact factor: 22.682
Authors: Justin M Belcher; Guadalupe Garcia-Tsao; Arun J Sanyal; Heather Thiessen-Philbrook; Aldo J Peixoto; Mark A Perazella; Naheed Ansari; Joseph Lim; Steven G Coca; Chirag R Parikh Journal: Clin J Am Soc Nephrol Date: 2014-09-02 Impact factor: 8.237
Authors: Juan P Arab; Juan C Claro; Juan P Arancibia; Jorge Contreras; Fernando Gómez; Cristian Muñoz; Leyla Nazal; Eric Roessler; Rodrigo Wolff; Marco Arrese; Carlos Benítez Journal: World J Hepatol Date: 2016-09-08