Reversal of Type I Hepato-Renal Syndrome with Terlipressin and Octreotide

Copaci, I.; Micu, L.; Chiriac, Grethi

doi:10.1016/s0168-8278(16)01240-x

Cited by 7 publications

(11 citation statements)

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“…All the patients were diagnosed as hepatorenal syndrome based on the International Ascites Club criterion. [ 20 , 21 ] Ten trials [ 8 – 10 , 13 – 15 , 19 , 23 – 25 ] only included type 1 HRS patients and three RCTs [ 12 , 16 , 17 ] only included type 2 HRS, the other 5 studies [ 6 – 7 , 11 , 18 , 26 ] had both types. The dosages of terlipressin were different among the RCTs, ranging from 1.5 to 12 mg/day depending on the patients’ condition.…”

Section: Resultsmentioning

confidence: 99%

“…The dosages of terlipressin were different among the RCTs, ranging from 1.5 to 12 mg/day depending on the patients’ condition. Twelve of the trails maintained a maximum terlipressin treatment duration of 2 weeks, but 2 studies [ 11 , 18 ] only had 5 days’ treatment and 4 RCTs [ 12 , 19 , 25 , 26 ] did not describe the duration. Seven RCTs [ 7 – 12 , 27 ] compared the efficacy and safety between terlipressin and placebo, 8 RCTs [ 14 – 17 , 19 , 23 , 24 , 26 ] compared between terlipressin and norepinephrine, 1 RCT [ 25 ] compared terlipressin with octreotide, 1 RCT [ 12 ] compared terlipressin with dopamine and the last RCT [ 6 ] compared terlipressin with octreotide and midodrine.…”

Section: Resultsmentioning

confidence: 99%

“…One RCT [ 25 ] investigated the difference between terlipressin and octreotide, and found that renal function improved was observed in both groups. However, terlipressin group had more hepatorenal syndrome reverse rate than the octreotide group (55% vs 20%, P = .01), the hepatorenal syndrome recurrence and adverse events were not reported.…”

Section: Resultsmentioning

confidence: 99%

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Terlipressin in the treatment of hepatorenal syndrome

Wang

Liu

et al. 2018

Medicine

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Background:Hepatorenal syndrome is a fatal complication of advanced cirrhosis. Terlipressin is the most widely used treatment method, however, the therapy effects remain inconsonant. We aim to systematically assess the safety and efficacy of terlipressin for hepatorenal syndrome.Methods:We conducted a systematic review and meta-analysis. Randomized controlled trials involving terlipressin for hepatorenal syndrome were included in a systematic literature search. Two authors independently assessed the studies for inclusion and extracted the data. A meta-analysis was conducted to estimate the safety and efficacy of terlipressin for hepatorenal syndrome.Results:A total of 18 randomized controlled trials including 1011 patients were included. Hepatorenal syndrome reverse rate was 42.0% in the terlipressin group and 26.2% in the non-terlipressin group. Terlipressin had greater hepatorenal syndrome reverse rate and renal function improvement rate than placebo and octreotide in the management of HRS. Comparing to norepinephrine, terlipressin had similar efficacy, but with more adverse events. No significant difference of the efficacy was found between terlipressin and dopamine treatment. The subgroup analysis for type 1 HRS had the above same results, except that the adverse events were not significant different between norepinephrine group and terlipressin group.Conclusions:Terlipressin was superior to placebo and octreotide for reversal of hepatorenal syndrome and improving renal function, but it had no superiority comparing to norepinephrine.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Terlipressin in the treatment of hepatorenal syndrome

Wang

Liu

et al. 2018

Medicine

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“…Numerous studies reported advantage of terlipressin over other vasoconstrictors. One RCT compared terlipressin versus octreotide and showed that terlipressin led to more HRS reversal than octreotide (55% vs 20%, P = 0.01) 21 . Another RCT compared terlipressin versus octreotide and midodrine.…”

Section: Discussionmentioning

confidence: 99%

“…One RCT compared terlipressin versus octreotide and showed that terlipressin led to more HRS reversal than octreotide (55% vs 20%, P = 0.01). 21 Another RCT compared terlipressin versus octreotide and midodrine. This study showed that terlipressin and albumin were more effective in reversing renal failure (55.5% vs 4.8%, P < 0.001) and improving renal function in HRS (70.4% vs 28.6%, P = 0.01).…”

Section: Discussionmentioning

confidence: 99%

Terlipressin effect on hepatorenal syndrome: Updated meta‐analysis of randomized controlled trials

et al. 2021

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Background and Aim Hepatorenal syndrome (HRS) is a fatal complication of liver cirrhosis with a limited pharmacological option. Terlipressin is a vasoconstrictor that is approved in many countries but not yet in the United States. This is a meta‐analysis of randomized controlled trials (RCTs) to review terlipressin effect on HRS and the safety profile. Methods We searched electronic databases for RCTs comparing terlipressin versus placebo in addition to albumin in patients with type 1 or 2 HRS. Primary outcome was HRS reversal. Secondary outcomes were change in serum creatinine (Cr), requirement for renal replacement therapy (RRT) at 30 days of randomization, and 90‐day survival. Risk ratios (RRs) and mean differences (MD) were calculated with 95% confidence intervals (CIs) using a random‐effects model. Results We identified eight RCTs with a total of 974 patients, and median follow up of 100 days. Mean age was 55 ± 10 years, 61% were males. Alcoholic liver disease represented 56%. Compared with placebo, terlipressin was associated with a significantly higher likelihood of HRS reversal (RR 2.08; 95% CI [1.51, 2.86], P < 0.001), significantly lower serum Cr (MD −0.64; 95% CI (−1.02, −0.27), P < 0.001], and a trend toward less RRT requirements (RR 0.61; 95% CI [0.36, 1.02], P = 0.06). There was no difference in survival at 90 days between groups (RR 1.09; 95% CI (0.84, 1.43), P = 0.52). Major adverse effects (AEs) were gastrointestinal cramps, discomfort, and respiratory distress. Conclusion In patients with liver cirrhosis complicated by HRS, terlipressin was associated with significant HRS reversal and decrease in serum Cr. No survival benefit was detected at 90 days.

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