Rifaximin has no effect on hemodynamics in decompensated cirrhosis: A randomized, double‐blind, placebo‐controlled trial

Abstract

Four weeks of treatment with rifaximin did not reduce the hepatic venous pressure gradient or improve systemic hemodynamics in patients with cirrhosis and ascites; rifaximin did not affect glomerular filtration rate or levels of vasoactive hormones. (Hepatology 2017;65:592-603).

No effect of rifaximin on soluble CD163, mannose receptor or type III and IV neoepitope collagen markers in decompensated cirrhosis: Results from a randomized, placebo controlled trial

“…However, our negative efforts to demonstrate such an effect is in line with our previous data from this randomized trial, where we found no effect of rifaximin-α on clinical parameters such as HVPG and cardiac output, no effect on biochemical parameters and inflammation markers (e.g. Tumor necrosis factor alpha and Interleukins 6, 10 and 18), and no effect on the composition of bacterial DNA in blood or stool [23, 24]. …”

“…Baseline characteristics and demography in the two groups are shown in Table 1 and reported previously [23, 24]. Trial flow chart is reported previously and in Fig 1 [24].…”

“…Exclusion criteria were cardiac or respiratory failure, invasive cancer within the past five years, clinical or biochemical signs of infection, antibiotic treatment 14 days prior to inclusion, overt hepatic encephalopathy, kidney failure with serum creatinine above 200 μmol/l, transfusion-requiring bleeding within one week prior to inclusion, blood hemoglobin level below 5.5 mmol/l, continuous abuse of alcohol with symptoms of withdrawal; or expected survival of less than 3 months. In- and exclusion criteria, as well as basal characteristics of the subjects have been described previously [23, 24]. Patients were invasively characterized with liver vein catheterization and measurement of cardiac output and hepatic venous pressure gradient, along with glomerular filtration rate, assessment of hepatic encephalopathy and biochemistry.…”

“…Patients were invasively characterized with liver vein catheterization and measurement of cardiac output and hepatic venous pressure gradient, along with glomerular filtration rate, assessment of hepatic encephalopathy and biochemistry. All had PH with a Hepatic Venous pressure Gradient (HVPG) of 12 mmHg or higher [24]. …”

Gut-Liver Axis Links Portal Hypertension to Acute-on-Chronic Liver Failure

“…However, the findings remain unconvincing to date. In some studies, rifaximin showed a major preventive effect [62,63], while in others, this effect could not be determined or was only minor [64,65]. Thus, while there is some evidence that some patients might benefit from rifaximin, a better selection and stratification of patients is required in the clinical setting.…”