A META-ANALYSIS COMPARING THE EFFICACY AND SAFETY OF TERLIPRESSIN AND OCTREOTIDE IN THE MANAGEMENT OF ACUTE VARICEAL BLEEDING

AKANKSHA MATHUR; ACHAL SHARMA

doi:10.22159/ajpcr.2019.v12i12.35509

Authors

AKANKSHA MATHUR Department of Pharmacology, Baroda Medical College, Vadodara, Gujarat, India.
ACHAL SHARMA Department of Medicine, Holy Family Hospital, Delhi, India.

DOI:

https://doi.org/10.22159/ajpcr.2019.v12i12.35509

Keywords:

Variceal bleeding, Esophageal varices, Vasoconstrictors, Terlipressin, Octreotide

Abstract

Objective: Various clinical trials have compared terlipressin and octreotide in the management of acute variceal bleed, but their results have been inconsistent. Therefore, the present meta-analysis was performed to compare the clinical efficacy and safety of terlipressin and octreotide and gather the strength of evidence regarding their use in variceal hemorrhage.

Methods: Randomized control trials were identified using PubMed search engine and Cochrane clinical trial register (from 1994 to 2019). Initial hemostasis rate, rebleeding rate on the 5th day, and overall mortality rate during the study period were studied. The extracted data were analyzed using review manager 5.3 software. Odds ratio with 95% confidence intervals (CI) was estimated for the dichotomous outcomes.

Results: A total of six randomized control trials were identified. Through comparisons of data for terlipressin and octreotide groups, we found no statistically significant differences in the initial hemostasis rate, rebleeding rate on the 5th day, and overall mortality rate between the different treatment approaches.

Conclusion: The comparison of terlipressin and octreotide showed them to be equally effective and safe therapeutic agents in patients of acute variceal bleeding. Further, evidence from the future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.

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Author Biography

ACHAL SHARMA, Department of Medicine, Holy Family Hospital, Delhi, India.

Resident, Department of Internal Medicine, Holy Family Hospital, Delhi

References

Sarin SK, Kumar A, Angus PW, Baijal SS, Baik SK, Bayraktar Y, et al. Diagnosis and management of acute variceal bleeding: Asian pacific association for study of the liver recommendations. Hepatol Int 2011;5:607-24.

Asad M, Alam MF. A comparison of terlipressin and octreotide for the control of esophageal variceal bleeding in patients of liver cirrhosis. Clin Exp Hepatol 2014;4:86-8.

Wells M, Chande N, Adams P, Beaton M, Levstik M, Boyce E, et al. Meta-analysis: Vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012;35:1267-78.

Seo YS, Park SY, Kim MY, Kim JH, Park JY, Yim HJ, et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology 2014;60:954-63.

Jüni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ 2001;323:42-6.

Review Manager (RevMan) [Computer Program]. Ver. 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014.

Abid S, Jafri W, Hamid S, Salih M, Azam Z, Mumtaz K, et al. Terlipressin vs. Octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: A randomized double-blind placebo-controlled trial. Am J Gastroenterol 2009;104:617-23.

Brunati XC, Curioni R, Brunelli L, Repaci G, Morini L. Sclerotherapy alone vs scherotherapy plus terlipressin vs sclerotherapy plus octreotide in the treatment of acute variceal hemorrhage. Hepatology 1996;24:207-8.

Cho SB, Park KJ, Lee JS, Lee WS, Park CH, Joo YE, et al. Comparison of terlipressin and octreotide with variceal ligation for controlling acute esophageal variceal bleeding a randomized prospective study. Korean J Hepatol 2006;12:385-93.

Pedretti G, Elia G, Calzetti C, Magnani G, Fiaccadori F. Octreotide versus terlypressin in acute variceal hemorrhage in liver cirrhosis. Emergency control and prevention of early rebleeding. Clin Investig 1994;72:653-9.

Zhou X, Tripathi D, Song T, Shao L, Han B, Zhu J, et al. Terlipressin for the treatment of acute variceal bleeding: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018;97:e13437.

Hegazy R, Moustafa R, El-meligy R. The therapeutic and neuroprotective effects of green tea in a rat model of terlipressin-induced chronic hyponatremia. Int J Pharm Pharm Sci 2016;8:253-9.