Carvedilol use is associated with improved survival in patients with liver cirrhosis and ascites

Abstract

The safety of carvedilol and other non-selective beta-blocker drugs in patients with liver cirrhosis and ascites is still debated. In this study, we have shown that carvedilol therapy in these patients was associated with reduced risk of mortality, particularly in those with mild ascites. We concluded that low dose, chronic treatment with carvedilol in patients with liver cirrhosis and ascites is not detrimental.

Comparison of Therapies for Primary Prevention of Esophageal Variceal Bleeding: A Systematic Review and Network Meta‐analysis

“…This is possibly attributed to the paucity of randomized controlled trials including carvedilol. Recently, a large retrospective study demonstrated a 41% reduction in mortality risk with carvedilol therapy . Therefore, larger prospective trials with carvedilol are needed to elucidate the potential benefits of this drug in patients with cirrhosis.…”

Beta‐blockers in patients with advanced liver disease: Has the dust settled?

“…Another propensity score–matched retrospective analysis of 264 patients with cirrhosis and ascites showed that carvedilol (median dose, 12.5 mg) was associated with a reduction of mortality risk when compared with patients not on carvedilol. Interestingly, the mortality benefit was no longer significant in patients with moderate or severe ascites, but carvedilol use was not associated with worse outcomes in these groups …”

PRO (“The Window Is Open”): In patients with cirrhosis with prior variceal hemorrhage and ascites, the clinical benefits of nonselective beta‐blockers outweigh the risks and should be prescribed

“…In contrast with Sersté et al's study, several larger, well‐designed, observational studies of patients with ascites have now demonstrated improved survival with NSBB therapy at modest doses (Table ) . The survival benefit of NSBBs extends to some of the sickest subgroups of patients with cirrhosis.…”

“…[6][7][8][9] In contrast with Serst e et al's 3 study, several larger, well-designed, observational studies of patients with ascites have now demonstrated improved survival with NSBB therapy at modest doses (Table 1). [5][6][7][8][9][10][11] The survival benefit of NSBBs extends to some of the sickest subgroups of patients with cirrhosis. In a multivariable, propensity risk score-matched competing risk Cox analysis of 322 patients with ascites wait-listed for liver transplantation, use of propranolol (with a median dose of 80 mg/day) or carvedilol (with a median dose of 6.25 mg/day) was associated with a 45% reduction in mortality in the overall cohort and a 65% reduction in mortality in the subgroup of patients with refractory ascites.…”