Is rifaximin better than nonabsorbable disaccharides in hepatic encephalopathy?

Abstract

Background: The purpose of the present meta-analysis was to compare the efficacy of rifaximin and nonabsorbable disaccharides (NADs) in hepatic encephalopathy (HE). Methods: After the registration of the present meta-analysis on INPLASY, all procedures were performed according to PRISMA 2020. Relevant literature was retrieved on PubMed, Embase, and the Cochrane Library up to September 5, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the enrolled studies, and Review Manager software (version 5.3) was used to analyze the clinical efficacy, blood ammonia and adverse effects. Results: Six studies with 559 patients were included in the present meta-analysis. There were no significant differences in the basic characteristics of the included studies. Analysis of the complete resolution of HE showed that rifaximin was better than NADs (risk ratio [RR] = 1.87, 95% confidence interval [CI] = 1.03–3.39, P = .04). However, there were no significant differences in mental status (RR = 1.04, 95% CI = 0.92–1.18, P = .53), blood ammonia level (standard mean difference = −0.02, 95% CI = −0.40–0.02, P = .08), or drug adverse drug effects (OR = 0.43, 95% CI = 0.10–1.77, I 2 = 56%, P = .24) between the rifaximin and NADs treatment groups. Conclusion: Rifaximin is not superior to NADs in the treatment of HE.

Update on the Role of Rifaximin in Digestive Diseases

“…Three meta-analyses have been recently carried out to investigate the effects of rifaximin in HE. Cheng et al [47] compared the efficacy of rifaximin to nonabsorbable disaccharides that involved 6 studies with 559 patients. In this meta-analysis, rifaximin was better than nonabsorbable disaccharides (RR=1.87) for resolution of HE, although there were no significant differences in mental status, blood ammonia, or adverse effects between rifaximin and nonabsorbable disaccharides.…”

Hepatische Enzephalopathie Teil 2: Therapie

“…In einer Metaanalyse von 10 Studien, die Rifaximin mit anderen HE-Therapien verglichen, fand sich in 9 Studien kein statistisch signifikanter Unterschied zur jeweiligen Kontrolltherapie [17]. Rifaximin erwies sich auch in weiteren Metaanalysen nicht besser als Lactulose zur Behandlung der oHE [18] oder mHE [19]. In der Sekundärprophylaxe zur Rezidivvermeidung nach oHE-Episode zeigten sich in einer hochrangig publizierten Studie signifikante Vorteile für die Kombination Rifaximin mit Lactulose gegenüber Lactulose allein.…”

Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis

“…Several traditional and network meta-analyses are available at present and are focused on the treatment of patients with HE. Early published studies suggested that rifaximin has similar efficacy to other active drugs but is better tolerated [ 13 – 16 ]. Subsequent studies have confirmed the benefit of rifaximin in HE treatment and its ability to reduce mortality [ 17 – 19 ] while improving health-related quality of life [ 20 ].…”