Rifaximin versus Nonabsorbable Disaccharides for the Treatment of Hepatic Encephalopathy: A Meta-Analysis

Abstract

Background. Many studies have found that the antibiotic rifaximin is effective for the treatment of hepatic encephalopathy. However, there is no uniform view on the efficacy and safety of rifaximin. Methods. We performed a meta-analysis through electronic searches to evaluate the efficacy and safety of rifaximin in comparison with nonabsorbable disaccharides. Results. A total of 8 randomized controlled trials including 407 patients were included. The efficacy of rifaximin was equivalent to nonabsorbable disaccharides according to the statistical data (risk ratio (RR): 1.06, 95% CI: 0.94–1.19; P = 0.34). Analysis showed that patients treated with rifaximin had better results in serum ammonia levels (weighted mean difference (WMD): −10.63, 95% CI: −30.63–9.38; P = 0.30), mental status (WMD: −0.32, 95% CI: −0.67–0.03; P = 0.07), asterixis (WMD: −0.12, 95% CI: −0.31–0.08; P = 0.23), electroencephalogram response (WMD: −0.21, 95% CI: −0.34–−0.09; P = 0.0007), and grades of portosystemic encephalopathy (WMD: −2.30, 95% CI: −2.78–−1.82; P < 0.00001), but only the last ones had statistical significance. The safety of rifaximin was better than nonabsorbable disaccharides (RR: 0.19, 95% CI: 0.10–0.34; P < 0.00001). Conclusion. Rifaximin is at least as effective as nonabsorbable disaccharides, maybe better for the treatment of hepatic encephalopathy. And the safety of rifaximin is better.

Systematic review with network meta‐analysis: the comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy

“…Our analysis showed that the treatment of RIF ranked first in reducing blood ammonia concentration among all interventions for patients with OHE. A traditional meta‐analysis in 2013 showed that patients in RIF group had lower serum ammonia levels vs. control group although this was not statistically significant. Consistent with this observation, our further pair‐wise meta‐analysis showed that RIF has a beneficial effect on HE and lowers serum ammonia with a mean difference of 7.10 lg/dL.…”

Meta-analysis of the efficacy of probiotics inHelicobacter pylorieradication therapy

“…The searches were mainly conducted in MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials [11,12] . The references cited in the included articles and relevant published reports were also searched manually.…”

Efficacy and safety of rifaximin in Japanese patients with hepatic encephalopathy: A phase II/III, multicenter, randomized, evaluator‐blinded, active‐controlled trial and a phase III, multicenter, open trial

“…Rifaximin, a poorly absorbable oral antimicrobial drug, was first developed in Italy in 1985 and has been approved and was used widely in 68 countries including the USA and European countries at the end of 2015 . The indications for this drug are HE (covert HE and overt HE), idiopathic PSE, or hyperammonemic state in chronic liver diseases.…”