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 24 May 2018

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News

Vasoactive drugs for the treatment of hepatorenal syndrome type 1

The latest issue of the Alimentary Pharmacology & Therapeutics re-evaluated efficacy and safety of pharmacological treatments for hepatorenal syndrome type 1.

News image

Hepatorenal syndrome type 1 is a functional, rapidly progressive, potentially reversible form of acute kidney injury occurring in patients with cirrhosis.
 
Characterized by intense renal arterial vasoconstriction, it carries a very poor prognosis. 

There is a significant unmet need for a widely approved, safe and effective pharmacological treatment.

Dr Fiona Gifford and colleagues from the United Kingdom re-evaluated efficacy and safety of pharmacological treatments for hepatorenal syndrome type 1, in the light of recently published randomized controlled trials.

MEDLINE (OvidSP), EMBASE, PubMed and Cochrane registers were searched for randomized controlled trials reporting efficacy and adverse events related to pharmacological treatment of hepatorenal syndrome type 1. 

Treatment with terlipressin and albumin led to hepatorenal syndrome type 1 reversal more frequently
Alimentary Pharmacology & Therapeutics
The team's search terms included: ‘hepatorenal syndrome’, ‘terlipressin’, ‘noradrenaline’, ‘octreotide’, ‘midodrine’, ‘vasopressin’, ‘dopamine’, ‘albumin’, and synonyms. 

Comparison of vasoactive drugs vs. placebo/no treatment, and 2 active drugs were included. 

The research team performed meta-analysis for hepatorenal syndrome type 1 reversal, creatinine improvement, mortality and adverse events.

The team included 12 randomized controlled trials enrolling 700 hepatorenal syndrome type 1 patients. 

Treatment with terlipressin and albumin led to hepatorenal syndrome type 1 reversal more frequently than albumin alone or placebo. 

The team of doctors observed that noradrenaline was effective in reversing hepatorenal syndrome type 1, but trials were small and nonblinded. 

Overall, the researchers observed that mortality benefit with terlipressin, but sensitivity analysis including only trials with low risk of selection bias weakened this relationship. 

Notably, there was a signifi cant risk of adverse events with terlipressin therapy.

Dr Gifford's team concludes, "Terlipressin treatment is superior to placebo for achieving hepatorenal syndrome type 1 reversal, but mortality benefit is less clear."

"Terlipressin is associated with significant adverse events, but infusion regimens may be better tolerated."

"There is continued need for safe and effective treatment options for hepatorenal syndrome."

Aliment Pharmacol Ther 2017: 45(5): 593–603
13 February 2017

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