The pharmacodynamic effect of terlipressin versus high-dose octreotide in reducing hepatic venous pressure gradient: a randomized controlled trial

Abstract

Background: Vasoactive drugs can reduce portal venous pressure and control variceal bleeding. However, few studies have explored the hemodynamic effects of terlipressin and high-dose octreotide in such patients.Our purpose was to evaluate the hemodynamic changes and safety of using terlipressin and high-dose octreotide in patients with decompensated liver cirrhosis.Methods: A multi-center randomized controlled trial was conducted. Cirrhotic patients with a history of variceal bleeding were included. Terlipressin or high-dose octreotide was administered during the procedure of measuring hepatic venous pressure gradient (HVPG). Hemodynamic parameters and symptoms were recorded.Results: A total of 88 patients were included. HVPG was significantly reduced at 10, 20, and 30 min after drug administration in the terlipressin group (16.3±6.4 vs. 14.7±5.9, 14.0±6.1, and 13.8±6.1, respectively, P<0.001) and the high-dose octreotide group (17.4±6.6 vs. 15.1±5.8, 15.3±6.2, and 16.1±6.0, respectively P<0.01). Decreased heart rate and increased mean arterial pressure were more often observed in the terlipressin group. The overall response rates were not significantly different between the groups (52.8% vs. 44.8%, P=0.524). The terlipressin group had significantly higher response rates at 30 min compared to the high-dose octreotide group in those with alcoholic liver cirrhosis [6/6 (100%) vs. 0/4 (0%), P=0.005]. The incidence of adverse drug events was rare and similar in the two groups.Conclusions: Both terlipressin and high-dose octreotide were effective and safe for reducing HVPG. The pharmacodynamic effect of terlipressin persisted longer. The terlipressin group had higher response rates in those with alcoholic cirrhosis (trial number: NCT02119884).

Comparison of 1‐day versus 3‐day intravenous terlipressin in cirrhosis patients with variceal bleeding: A pilot randomised controlled trial

“…The reduction in HVPG after a single bolus dose of terlipressin is larger in magnitude and faster in onset compared to somatostatin and octreotide. This reduction in HVPG is also sustained for a longer duration of time compared with somatostatin and octreotide 22,23 . A prior Cochrane systematic review also reported a potential survival benefit with terlipressin use along with a similar adverse effect profile in comparison to somatostatin and octreotide 24 .…”

“…This reduction in HVPG is also sustained for a longer duration of time compared with somatostatin and octreotide. 22,23 A prior Cochrane systematic review also reported a potential survival benefit with terlipressin use along with a similar adverse effect profile in comparison to somatostatin and octreotide. 24 This led us to choose terlipressin as the vasoactive agent of choice for our study.…”

Guidelines for the Management of Esophagogastric Variceal Bleeding in Cirrhotic Portal Hypertension

“…76 Drug-assisted endoscopic therapy: Portal pressure reducing agents can significantly reduce HVPG, improve the safety and efficacy of endoscopic therapy, and reduce recent rebleeding. 77 Terlipressin or octreotide as an adjuvant to EVL leads to a hemostasis rate of 98% and 96%, respectively; Rebleeding rates at 5 days and 42 days were 12%/9% and 28%/24%, respectively; There were no significant differences between the two groups. Routine use of the prothrombin complex, fresh frozen plasma, and fibrinogen is not recommended to reduce the incidence of bleeding related to endoscopic therapy to avoid portal vein thrombosis.…”