Terlipressin for hepatorenal syndrome

Kjaer, MS; Taastroem, A; Christensen, Erik

doi:10.1002/14651858.cd005162

Cited by 7 publications

(14 citation statements)

References 32 publications

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“…Terlipressin promotes vasoconstriction in both systemic and splanchnic circulation through activation of V1 receptors of the vascular smooth muscle cells and is reported to reduce portal inflow, portal systemic shunting [17] ; and to dilate intrahepatic vessels, consequently reducing intrahepatic resistance to portal inflow [18] . The overall results of the use of terlipressin in conjunction with albumin in the treatment of HRS are an improvement in renal function and an increase in the median survival time as demonstrated in clinical trials and confirmed by at least three meta-analyses [4] , [19] , [20] . Although terlipressin has become the vasoactive drug of choice where available, a Cochrane meta-analysis has pointed out that all randomized controlled studies that addressed the efficacy of terlipressin were underpowered and at high risk of bias [4] .…”

Section: Discussionmentioning

confidence: 78%

“…The overall results of the use of terlipressin in conjunction with albumin in the treatment of HRS are an improvement in renal function and an increase in the median survival time as demonstrated in clinical trials and confirmed by at least three meta-analyses [4] , [19] , [20] . Although terlipressin has become the vasoactive drug of choice where available, a Cochrane meta-analysis has pointed out that all randomized controlled studies that addressed the efficacy of terlipressin were underpowered and at high risk of bias [4] . Additionally, the evidence on the use of terlipressin in type 2 HRS is scarce since these patients were included in only one trial [21] .…”

Section: Discussionmentioning

confidence: 78%

“…Since the arterial vasodilation seems to be a key mechanism in the pathogenesis of HRS, vasoconstrictors have been used as a bridging therapy leading up to the definitive treatment; liver transplantation. The vasopressin analog terlipressin is the most widely studied drug, especially in type 1 HRS [4] . However, it is expensive and unavailable in many countries.…”

Section: Introductionmentioning

confidence: 99%

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Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundHepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS.MethodsWe searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events.ResultsFour studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83).ConclusionsNorepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

et al. 2014

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“…Studies were limited by small patient cohorts, ranging from 3 to 31 type 2 patients treated with terlipressin. Meta‐analyses concluded that the number of HRS type 2 patients in published studies addressing the role of terlipressin was too small for conclusive treatment recommendations 16–18 . In consequence current guidelines of the European Association for the Study of Liver Disease (EASL) as well as the American Association for the Study of Liver Disease do not recommend vasoconstrictor treatment in HRS Type 2/HRS‐NAKI 5 , 19 …”

Section: Introductionmentioning

confidence: 99%

Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2

Nguyen-Tat¹,

Jäger²,

Nagel³

et al. 2019

UEG Journal

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Background Hepatorenal syndrome (HRS) is associated with a poor prognosis. In HRS type 1, loss of renal function is rapidly progressive, while HRS type 2 is characterised by chronic ascites and more moderately elevated renal parameters. While treatment with terlipressin/albumin is well established in type 1, its effectiveness in chronic HRS is less clear. Objective The aim of this study was to evaluate the effectiveness of terlipressin/albumin treatment in patients with HRS type 2. Methods All patients with a first episode of HRS between April 2013 and February 2016 were included in this observational study. Relevant clinical and laboratory parameters were recorded and patients were followed. Results A total of 106 patients with HRS were included. With terlipressin therapy reversal of HRS types 1 and 2 was achieved in 48% and 46% of patients ( p = 0.84) with relapse rates of 8% vs 50% ( p = 0.001). Overall survival (OS) and survival free of liver transplantation (LTx) were similar in HRS types 1 and 2 ( p = 0.69; p = 0.64). In multivariate analysis response to treatment was independently associated with better OS in HRS type 2, in addition to established risk factors such as lower Model for End-Stage Liver Disease score, absence of hepatic encephalopathy and eligibility for LTx. Conclusion A terlipressin treatment course seems to be justified in selected patients with HRS type 2, especially in countries and settings with long transplant waiting lists. In addition treatment response might also help to identify HRS type 2 patients with a more favourable outcome.

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“…The impact of study design, comparison of responders and nonresponders and consideration of transplantation on these endpoints is unclear. 18,19 Choosing the appropriate primary outcome measure ⁄ endpoint is crucial in designing a trial to ensure that the results are clinically meaningful. When considering the proper outcome measures for HRS trials, three major questions arise.…”

Section: Introductionmentioning

confidence: 99%

Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials

Tandon¹,

Bain²,

Tsuyuki³

et al. 2007

Aliment Pharmacol Ther

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Terlipressin for hepatorenal syndrome

Cited by 7 publications

References 32 publications

Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

Terlipressin and albumin combination treatment in patients with hepatorenal syndrome type 2

Systematic review: renal and other clinically relevant outcomes in hepatorenal syndrome trials

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