Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study

Abstract

In patients with cirrhosis and hepatorenal syndrome (HRS), terlipressin has been used either as continuous intravenous infusion or as intravenous boluses. To date, these two approaches have never been compared. The goal of this study was to compare the administration of terlipressin as continuous intravenous infusion versus intravenous boluses in the treatment of type 1 HRS. Seventy-eight patients were randomly assigned to receive either continuous intravenous infusion (TERLI-INF group) at the initial dose of 2 mg/day or intravenous boluses of terlipressin (TERLI-BOL group) at the initial dose of 0.5 mg every 4 hours. In case of no response, the dose was progressively increased to a final dose of 12 mg/day in both groups. Albumin was given at the same dose in both groups (1 g/kg of body weight at the first day followed by 20-40 g/day). Complete response was defined by decrease of serum creatinine (sCr) from baseline to a final value £ 133 lmol/L, partial response by a decrease 50% of sCr from baseline to a final value >133 lmol/L. The rate of adverse events was lower in the TERLI-INF group (35.29%) than in the TERLI-BOL group (62.16%, P < 0.025). The rate of response to treatment, including both complete and partial response, was not significantly different between the two groups (76.47% versus 64.85%; P value not significant). The mean daily effective dose of terlipressin was lower in the TERLI-INF group than in the TERLI-BOL group (2.23 6 0.65 versus 3.51 6 1.77 mg/day; P < 0.05). Conclusion: Terlipressin given by continuous intravenous infusion is better tolerated than intravenous boluses in the treatment of type 1 HRS. Moreover, it is effective at doses lower than those required for intravenous bolus administration. (HEPATOLOGY 2016;63:983-992)

Terlipressin given by continuous intravenous infusion or by intravenous boluses: Is there already an answer?

“…This letter regards the recently published article by Cavallin et al (1) The authors compared terlipressin given by continuous intravenous infusion (TERLI-INF) and by intravenous boluses for hepatorenal syndrome and concluded that TERLI-INF is the most suitable approach because it was safer and required lower doses.…”

Cutaneous necrosis secondary to terlipressin therapy. A rare but serious side effect. Case report and literature review

“…In two cases, continuous perfusion was used with 9 and 12 mg/day respectively. A recently published study (10) suggests that continuous infusion could avoid secondary effects, as lower doses of the drug are needed. However, none of the patients within this study presented with cutaneous necrosis; they only report one isolated peripheral ischemia case within the continuous infusion group.…”

Updates on hepatorenal syndrome and strategies bridging to liver transplantation

“…[23] The adverse effects of terlipressin may be minimized by means of intravenous infusion rather than bolus injections as shown in a recent randomized controlled study in Italy. [24] Although most commonly used and studied, terlipressin is expensive and unavailable in many countries. Other vasoconstrictive agents are used as well.…”