P440 Outcomes of Rifaximin Plus Lactulose Versus Lactulose Alone in Treatment of Overt Hepatic Encephalopathy

Gill, Muzaffar Lateef; Niaz, T.; Aziz, Hossam Abd El; Khan, S.

doi:10.1016/s0168-8278(14)60602-4

Cited by 3 publications

(5 citation statements)

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“…Randomized studies were regarded to be better than non-randomized studies in the study design; accordingly, we analyzed the result based on only randomized studies (Figure 3). In the new pooled analysis, three studies containing 342 HE patients also demonstrated a significant increase in clinical efficacy of combination therapy (RD 0.25, 95% CI 0.16–0.35, P <0.00001, I 2 =0%) 13,15,16…”

Section: Resultsmentioning

confidence: 95%

“…Three studies reported the data of hospital stay. Two of them were pooled analyzed, and meta-analysis results showed that combination therapy significantly reduced the duration of hospital stay (MD −2.89, 95% CI −3.52 to −2.25, P <0.00001) 15,16. The other study only reported the data of median hospital stay between the groups (6/8, P =0.09),18 which found no significant difference.…”

Section: Resultsmentioning

confidence: 97%

“…Among them, HE grade >1 was diagnosed as overt HE, which indicated that clinical findings such as lethargy or apathy, disorientation for time, and obvious personality change were reproducible. The dose of rifaximin was fixed in the studies that 1,100 mg therapy was adopted in five studies,13,14,16–18 and 1,200 mg therapy was adopted in four studies 15,19–21. The volume of lactulose varied in each study, ranging from 60 mL to 180 mL (the amount was 667 mg in 1 mL).…”

Section: Resultsmentioning

confidence: 99%

“…Five randomized studies were assessed by JADAD scale;13,15,16,18,21 three of them had a score >315,18,21 and three of them designed a placebo control 15,16,21. Four observational studies were assessed by NOS scale,14,17,19,20 and three of them had a score >4 17,19,20.…”

Section: Resultsmentioning

confidence: 99%

“…In the new pooled analysis based on randomized studies, two studies containing 280 patients demonstrated a significant decrease of mortality in combination therapy (RD −0.22, 95% CI −0.33 to −0.12, P <0.0001, I 2 =0%; Figure 7). 15,16…”

Section: Resultsmentioning

confidence: 99%

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Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy

Wang¹,

Chu²,

Wang³

2018

DDDT

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BackgroundRifaximin and lactulose are common effective agents for hepatic encephalopathy (HE). Whether a combination of rifaximin and lactulose improves the efficacy and mortality in patients with HE compared with lactulose alone needs to be analyzed.MethodsA systematic search was performed in electronic databases and other sources for possible studies focusing on combination therapy of rifaximin and lactulose for HE between January 2000 and February 2018. A meta-analysis was performed by the method recommended by the Cochrane Collaboration, and estimated effect size was presented as risk difference (RD), 95% CI, and the number needed to treat (NNT). Subgroup analysis, sensitivity analysis, and Trial Sequence Analysis were comprehensively performed to indicate the source of heterogeneity and risk of bias.ResultsFive randomized and five observational studies involving 2,276 patients were included. Combination therapy had a significant advantage in both clinical efficacy increase (RD 0.26, 95% CI 0.19–0.32, NNT 5) and mortality decrease (RD −0.16, 95% CI −0.20–0.11, NNT 9) in overall analysis. In the pooled analysis of randomized studies, combination therapy showed similar results in clinical efficacy (RD 0.25, 95% CI 0.16–0.35, NNT 4) and mortality (RD −0.22, 95% CI −0.33–0.12, NNT 5). Compared with lactulose, hospital stay was also reduced in combination therapy, and there was no significant difference in treatment-related adverse events between the two groups.ConclusionCombination of rifaximin and lactulose has beneficial effects on HE. Compared with lactulose alone, additional rifaximin increases clinical efficacy and decreases mortality. However, its effects on different types of HE are still uncertain.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy

Wang¹,

Chu²,

Wang³

2018

DDDT

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Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis

Zacharias

Kamel

Tan

et al. 2023

Cochrane Database of Systematic Reviews

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Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis

Gao

Shi

2022

PLoS ONE

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Rifaximin and lactulose are widely used in patients with hepatic encephalopathy (HE); however, data on whether the combined use of rifaximin and lactulose could yield additional benefits for patients with HE are limited and inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the treatment effectiveness of rifaximin plus lactulose versus lactulose alone in patients with HE. Electronic databases (PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure) were searched for eligible RCTs from their inception until November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to calculate pooled effect estimates for the treatment effectiveness of rifaximin plus lactulose versus lactulose alone by using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. We included 7 RCTs enrolling 843 patients with HE. We noted that the use of rifaximin plus lactulose was associated with an increased incidence of effective rate than lactulose alone (RR, 1.30; 95% CI, 1.10–1.53; P = 0.002). Moreover, the use of rifaximin plus lactulose was associated with a reduced risk of mortality as compared with lactulose alone (RR, 0.57; 95% CI, 0.41–0.80; P = 0.001). This study found that the use of rifaximin in combination with lactulose could provide additional benefits in terms of increased effective rate and decreased mortality than lactulose alone in patients with HE.

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P440 Outcomes of Rifaximin Plus Lactulose Versus Lactulose Alone in Treatment of Overt Hepatic Encephalopathy

Cited by 3 publications

References 0 publications

Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy

Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy

Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis

Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis

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