Background:
After 5 years since the registration of rifaximin-α as a secondary
prophylaxis for overt hepatic encephalopathy (HE) in the Netherlands, we
aimed to evaluate the use of hospital resources and safety of rifaximin-α
treatment in a real-world setting.
Methods:
We carried out prospective identification of all patients using rifaximin-α
for overt HE. We assessed hospital resource use, bacterial infections, and
adverse events during 6-month episodes before and after rifaximin-α
initiation.
Results:
During 26 months we included 127 patients [71.7% male; median age 60.8 years
(interquartile range: 56.2–66.1); median model for end-stage liver disease
(MELD) score 15.0 (interquartile range: 12.1–20.4); 98% using lactulose
treatment]. When comparing the first 6 months after rifaximin-α initiation
with the prior 6 months, HE-related hospital admissions decreased (0.86 to
0.41 admissions/patient;
p
< 0.001), as well as the mean
length of stay (8.85 to 3.79 bed days/admission;
p
< 0.001). No significant differences were found
regarding HE-related intensive care unit admissions (0.09 to
0.06 admission/patient;
p
= 0.253), stay on the intensive
care unit (0.43 to 0.57 bed days/admission;
p
= 0.661),
emergency department visits (0.66 to 0.51 visits/patient;
p
= 0.220), outpatient clinic visits (2.49 to 3.30 bed
visits/patient;
p
= 0.240), or bacterial infections (0.41
to 0.35 infections/patient;
p
= 0.523). Adverse events were
recorded in 2.4% of patients.
Conclusions:
The addition of rifaximin-α to lactulose treatment was associated with a
significant reduction in the number and length of HE-related
hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.
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