Carvedilol versus propranolol effect on hepatic venous pressure gradient at 1 month in patients with index variceal bleed: RCT

Abstract

Carvedilol is more effective in reducing portal pressure in patients with cirrhosis with esophageal bleed. Though a larger study is required to substantiate this, the results in this study are promising for carvedilol. Clinical trials online government registry (CTRI/2013/10/004119). Trial registration number CTRI/2013/10/004119.

Secondary prophylaxis for variceal bleeding: carvedilol vs. propranolol

“…In this trial, patients were randomized to either the propranolol or the carvedilol group independently of an event or not of bleeding. In contrast in the study [4] published in this issue of Hepatology International (pp. 000-000), only patients with cirrhosis presenting with the first episode of variceal bleeding from June to December 2013 were screened for inclusion criteria.…”

Carvedilol for prevention of variceal bleeding: a systematic review and meta analysis

“…Subsequently, the remaining 39 records were assessed at full text level. Twenty-two records describing 13 [20][21][22][23][24][25][26][27][28][29][30][31][32] trials (1598 patients) were finally included in the meta-analysis.…”

“…Secondary prophylaxis was evaluated in 6 trials comparing carvedilol with EVL [27,28,32], propranolol [29] or NSBBs plus isosorbide-5-mononitrate (ISMN) [27,31]. One trial compared carvedilol with propranolol for secondary prophylaxis on top of EVL therapy [30]. Only 1 placebo-controlled trial assessed the efficacy of carvedilol for prevention of variceal progression [26].…”

“…Among secondary prevention trials, 1 was at low risk of bias [31], whereas 3 trials were at high risk of bias [27,28,32] because of an inadequate description of the randomization process, poor blinding and missing outcome data. Finally, there were some concerns about the overall risk of bias for the remaining 2 trials [29,30], due to missing outcome data and the type of analysis used (per protocol). The risk-of-bias assessment for the secondary outcomes is presented in the supplemental digital content (Supplementary material, Tables S4-S9).…”

“…On the other hand, existing guidelines do not support the use of carvedilol for secondary prophylaxis, given the lack of evidence comparing carvedilol to standard of care. However, we identified 2 small trials in which carvedilol was found to be as efficacious as propranolol in preventing rebleeding after variceal eradication with EVL [29,30]. In addition, our review showed that carvedilol improves survival compared with EVL, even though they have a similar effect on the risk of rebleeding.…”