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News

Carvedilol vs propranolol for portal hypertension in cirrhosis

The latest issue of the Alimentary Pharmacology & Therapeutics investigates the hemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis.

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Propranolol is recommended for prophylaxis of variceal bleeding in cirrhosis.

Carvedilol is a nonselective beta-blocker with a mild anti-alfa-1-adrenergic activity.

Several studies have compared carvedilol and propranolol, yielding inconsistent results.

Dr D'Amico and colleagues from Italy performed a systematic review and meta-analysis of the randomized clinical trials comparing carvedilol with propranolol for hepatic vein pressure gradient reduction.

Studies were searched on the MEDLINE, EMBASE and Cochrane library databases up to November 2013.

Indication to treatment was primary prophylaxis of variceal bleeding in 76% of patients
Alimentary Pharmacology & Therapeutics

The weighted mean difference in percent hepatic vein pressure gradient reduction and the relative risk of failure to achieve a hemodynamic response with each drug were used as measures of treatment efficacy.

The research team included 5 studies.

Indication to treatment was primary prophylaxis of variceal bleeding in 76% of patients.

There were overall 3 acute (60–90 min after drug administration) and 3 long-term (after 7–90 days of therapy) comparisons.

The team found that the summary mean weighted difference in % of reduction in hepatic vein pressure gradient was −7.70% for acute, −6.81% for long-term, −7.24% for overall, favoring carvedilol.

The research team found that summary relative risk of failure to achieve a hemodynamic response with carvedilol was 0.66.

Adverse events were nonsignificantly more frequent and serious with carvedilol. However, quality of trials was mostly unsatisfactory.

Dr D'Amico's team concluded, "Carvedilol reduces portal hypertension significantly more than propranolol."

"However, available data do not allow a satisfactory comparison of adverse events."

"These results suggest a potential for a cautious clinical use."

Aliment Pharmacol Ther 2014: 39(6): 557–568
27 February 2014

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