THE TREATMENT OF HEPATORENAL SYNDROME WITH TERLIPRESSIN: CONTINUOUS INTRAVENOUS INFUSION VS INTRAVENOUS BOLUSES A RANDOMISED CONTROLLED STUDY ON SYNDROME

SURESH ARYA; SHRAVAN JANNU; AMIT MATHUR

doi:10.22159/ijcpr.2023v15i5.3071

Authors

SURESH ARYA Department of Gastroenterology, NIMS University, Jaipur, Rajasthan, India
SHRAVAN JANNU Department of Gastroenterology, NIMS University, Jaipur, Rajasthan, India
AMIT MATHUR Manglam Hospital Jaipur, Rajasthan, India

DOI:

https://doi.org/10.22159/ijcpr.2023v15i5.3071

Keywords:

Hepatorenal syndrome, Terlipressin, Continuous infusion, Intravenous boluses, cirrhosis, Adverse events, Therapy response, Survival prediction

Abstract

Objective: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis, with terlipressin and albumin being the most common treatment. The study aimed to compare the effectiveness and safety of continuous intravenous infusion vs. intravenous boluses of terlipressin in treating type 1 h.

Methods: A randomized controlled trial was conducted on cirrhosis patients with type 1 h. Patients were allocated to receive terlipressin via continuous infusion (TERLI-INF group) or intravenous boluses (TERLI-BOL group). Demographic, clinical, and laboratory data were collected, and treatment details were recorded. The primary endpoint was the frequency of drug-related adverse events. Secondary endpoints included therapy responsiveness and 90-day transplant-free survival.

Results: Both groups exhibited similar baseline characteristics. While treatment length and cumulative albumin doses were comparable, TERLI-INF patients received lower terlipressin doses. Severe treatment-related adverse events differed between groups. Univariate analysis identified several baseline parameters significantly associated with response to terlipressin. The study supports continuous terlipressin infusion's superiority in treating type 1 h, with lower adverse event rates and improved patient response.

Conclusion: The study concludes that continuous intravenous terlipressin infusion is safer and more effective in treating type 1 h in decompensated cirrhosis patients compared to intravenous boluses. Lower terlipressin dosages were effective in continuous infusion, indicating improved safety. The MELD score was an independent predictor of response, and therapy responsiveness was associated with improved 90 d survival.

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References

Sanyal AJ, Boyer T, Garcia Tsao G, Regenstein F, Rossaro L, Appenrodt B. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008;134(5):1360-8. doi: 10.1053/j.gastro.2008.02.014, PMID 18471513.

Martin Llahi M, Pepin MN, Guevara M, Diaz F, Torre A, Monescillo A. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008;134(5):1352-9. doi: 10.1053/j.gastro.2008.02.024, PMID 18471512.

Motohashi I, Okudaira M, Takai T, Kaneko S, Ikeda N. Morphological differences between hepatocellular carcinoma and hepatocellular carcinoma like lesions. Hepatology. 1992;16(1):118-26. doi: 10.1002/hep.1840160120.

Boyer TD, Sanyal AJ, Wong F, Frederick RT, Lake JR, O’Leary JG. Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1. Gastroenterology. 2016;150(7):1579-1589.e2. doi: 10.1053/j.gastro.2016.02.026, PMID 26896734.

Fernandez J, Monteagudo J, Bargallo X. A randomized unblinded pilot study comparing albumin versus albumin plus terlipressin for the treatment of type 1 hepatorenal syndrome in patients with cirrhosis. J Hepatol. 2017;67(1):123-30. doi: 10.1016/j.jhep.2017.02.025.

Bernardi M, Maggioli C, Zaccherini G. 10 y’ experience with the continuous infusion of terlipressin in cirrhotic patients with severe hyponatremia. Liver Int. 2010;30(8):1080-6. doi: 10.1111/j.1478-3231.2010.02258.x.

Boyer TD, Sanyal AJ, Wong F, Frederick RT, Lake JR, O’Leary JG. Terlipressin plus albumin is more effective than albumin alone in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1. Gastroenterology. 2016;150(7):1579-89.e2. doi: 10.1053/j.gastro.2016.02.026, PMID 26896734.

Solanki P, Chawla A, Garg R, Gupta R, Jain M, Sarin SK. Beneficial effects of terlipressin in hepatorenal syndrome: a prospective, randomized placebo-controlled clinical trial. J Gastroenterol Hepatol. 2003;18(2):152-6. doi: 10.1046/j.1440-1746.2003.02934.x. PMID 12542598.

Martin Llahi M, Guevara M, Torre A, Fagundes C, Restuccia T, Gilabert R. Prognostic importance of the cause of renal failure in patients with cirrhosis. Gastroenterology. 2011;140(2):488-496.e4. doi: 10.1053/j.gastro.2010.07.043, PMID 20682324.

Skagen C, Einstein M, Lucey MR, Said A. Combination treatment with octreotide, midodrine, and albumin improves survival in patients with type 1 and type 2 hepatorenal syndrome. J Clin Gastroenterol. 2009;43(7):680-5. doi: 10.1097/MCG.0b013e318188947c, PMID 19238094.

Motohashi I, Okudaira M, Takai T, Kaneko S, Ikeda N. Morphological differences between hepatocellular carcinoma and hepatocellular carcinoma like lesions. Hepatology. 1992;16(1):118-26. doi: 10.1002/hep.1840160120.

Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichaï P. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122(4):923-30. doi: 10.1053/gast.2002.32364, PMID 11910344.