Rifaximin is recommended for prevention of hepatic encephalopathy.
The effects of rifaximin on overt and minimal hepatic encephalopathy are debated.
Dr Kimer and colleagues from Denmark performed a systematic review and meta-analysis of randomized controlled trials on rifaximin for hepatic encephalopathy.
The research team performed electronic and manual searches, gathered information from the U.S. Food and Drug Administration Home Page, and obtained unpublished information on trial design and outcome measures from authors and pharmaceutical companies.
Meta-analyses were performed and results presented as risk ratios with 95% confidence intervals and the number needed to treat.
Subgroup, sensitivity, regression and sequential analyses were performed to evaluate the risk of bias and sources of heterogeneity.
|Rifaximin increased the proportion of patients who recovered from hepatic encephalopathy|
|Alimentary Pharmacology & Therapeutics|
The researchers included 19 randomized controlled trials with 1370 patients.
Outcomes were recalculated based on unpublished information of 11 trials.
Overall, rifaximin had a beneficial effect on secondary prevention of hepatic encephalopathy, but not in a sensitivity analysis on rifaximin after TIPSS.
The team found that rifaximin increased the proportion of patients who recovered from hepatic encephalopathy, and reduced mortality.
The team observed that the results were robust to adjustments for bias control.
No small study effects were identified.
The researchers noted that the sequential analyses only confirmed the results of the analysis on hepatic encephalopathy recovery.
Dr Kimer and team comment, "Rifaximin has a beneficial effect on hepatic encephalopathy and may reduce mortality."
"The combined evidence suggests that rifaximin may be considered in the evidence-based management of hepatic encephalopathy."