PWE-125 Rifaximin Treatment In Hepatic Encephalopathy (he) -– Marked Reduction In Hospital Admissions And Hospital Bed Day Occupancy In A District General Hospital

Goel, Anurag; Patel, Neena; Blackwell, Rebecca; Crompton, Sandra; Moriarty, KJ

doi:10.1136/gutjnl-2014-307263.385

Cited by 3 publications

(3 citation statements)

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“…Treatment with rifaximin-α was well-tolerated and associated with significant reductions in all-cause hospitalisations and bed days, affirming the findings of previous randomised controlled trials (RCTs) and UK audits. 14–18 Also, importantly, there were significant reductions in critical care admissions and bed days, non-elective admissions, 30-day emergency readmissions and ED attendances, which have not been demonstrated previously. Statistically significant reductions in liver-related resource use were observed within 6 months of treatment initiation and largely sustained at 12 months.…”

Section: Discussionmentioning

confidence: 56%

“…This is critical to enable clinical decision makers to evaluate the cost-effectiveness of rifaximin-α in routine clinical practice. A number of UK audits have shown reductions in all-cause hospitalisations and bed occupancy with rifaximin-α treatment, 14–18 but these were mainly single-centre studies and the results need to be confirmed in a range of centres using a standardised data collection methodology. To date, no European studies have been published on the impact of rifaximin-α on critical care admissions, emergency department (ED) attendances and 30-day emergency readmissions.…”

Section: Introductionmentioning

confidence: 99%

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The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Hudson

Radwan

Maggio

et al. 2017

Frontline Gastroenterol

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ObjectiveTo compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation in UK patients with hepatic encephalopathy (HE).DesignA UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-α. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-α and post-rifaximin-α initiation were extracted from hospital electronic databases.Setting13 National Health Service centres.Patients207 patients with HE who initiated rifaximin-α between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients.Main outcome measureChange in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-α and post-rifaximin-α initiation.ResultsComparing the 6 months pre-rifaximin-α and post-rifaximin-α initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs.ConclusionsIn UK clinical practice, treatment with rifaximin-α for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Hudson

Radwan

Maggio

et al. 2017

Frontline Gastroenterol

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“…Moreover, a recent placebo cross‐over study confirmed the safety and efficacy of rifaximin in reducing the risk of HE recurrence . Other studies also found that rifaximin was well tolerated and associated with significant reductions in hospitalisations, bed days, emergency department attendances and 30‐day readmissions . In addition, a recent retrospective study showed that rifaximin treatment was significantly associated with prolonged overall survival and reduced recurrent HE .…”

Section: Introductionmentioning

confidence: 84%

Effects of rifaximin versus nonabsorbable disaccharides in hepatic encephalopathy

et al. 2018

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Background: Lactulose is recommended as secondary prophylaxis after the initial episode and rifaximin as an add-on to lactulose for preventing recurrent episodes of hepatic encephalopathy (HE) after the second episode. However, the relative merits of rifaximin vs nonabsorbable disaccharides (NADs) on overt and minimal HE (MHE) are debated.Aim: This study aimed to perform a meta-analysis of randomised controlled trials (RCTs) on rifaximin vs NADs in HE.Methods: Electronic and manual searches were performed. The results presented as risk ratios or standardised mean difference with 95% confidence intervals. Sensitivity analyses were performed to evaluate the risk of bias and sources of heterogeneity. Results:In total, 8 RCTs were included, and only 7 RCTs with 386 patients were merged for meta-analysis. Meta-analyses showed that rifaximin appears better at reducing the blood ammonia levels compared with NADs, and that both rifaximin and NADs were well tolerated with few adverse effects. There were however, no significant differences in clinical efficacy or ability to reverse MHE between the two treatments. Most of the included studies were of low quality with a high risk of bias, leading to a low statistical power. Conclusions:Rifaximin had a beneficial effect on blood ammonia levels compared with NADs, and both rifaximin and NADs have good tolerance. However, no difference in the clinical efficacy and MHE reversal was observed between them.

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Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom

Berni

Murphy

Whitehouse

et al. 2018

Current Medical Research and Opinion

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PWE-125 Rifaximin Treatment In Hepatic Encephalopathy (he) -– Marked Reduction In Hospital Admissions And Hospital Bed Day Occupancy In A District General Hospital

Cited by 3 publications

References 0 publications

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

The impact of rifaximin-α on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS)

Effects of rifaximin versus nonabsorbable disaccharides in hepatic encephalopathy

Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom

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