SUNY Downstate Health Sciences University Brooklyn, NY, United States
Bhesh R. Karki, MD1, Dhan B. Shrestha, MD2, Pravash Budhathoki, MD3, Yub Raj Sedhai, MD4, Sanju Dahal, MBBS5, Anu Gautam, MBBS5, Samikshya Shukla, MBBS5 1SUNY Downstate Health Sciences University, Brooklyn, NY; 2Mount Sinai Hospital, Chicago, IL; 3BronxCare Health System, Bronx, NY; 4Virginia Commonwealth University School of Medicine, Richmond, VA; 5Nepalese Army Institute of Health Sciences, Kathmandu, Bagmati, Nepal
Introduction: Hepatorenal syndrome (HRS) is characterized by kidney injury due to liver disease and is associated with significant morbidity and mortality. There is no single drug that has been shown to completely reverse the deranged kidney function. Terlipressin is one of the vasoconstrictors that is used in Europe to treat the HRS, while the standard management in the US includes midodrine, octreotide, and albumin. We thus conducted a metanalysis to compare these two treatment options.
Methods: Search in multiple electronic databases (PubMed, PubMed Central, Scopus, Cochrane Library, Embase) was carried out using appropriate keywords for available literature published till December 2020. The collected data was analyzed with RevMan 5.4 for Odds ratio estimation.
Results: There were only 2 studies with a comparison between the terlipressin plus albumin (TA) group and midodrine, octreotide plus albumin (MOA) group that fulfilled the inclusion criteria. The TA group had significantly higher overall (partial or complete) and complete renal failure reversal compared to the MOA group [(OR, 5.49; 95% CI 2.18- 13.78) and (OR, 24.15; 95% CI 4.22- 138.29) respectively]. There was also a significantly higher 3-month survival rate in the TA group in comparison to the MOA group (OR, 2.41; 95% CI, 0.55- 10.46).
Discussion: HRS is a major complication and usually a late manifestation of liver cirrhosis. Although liver transplantation is the definitive treatment, multiple vasoconstrictors have been used. Few studies have shown the beneficial effect of terlipressin, however, data comparing the effect of terlipressin plus albumin with midodrine, octreotide plus albumin is limited.
Prior metanalyses have included a comparison of terlipressin with placebo, norepinephrine, octreotide, and dopamine, however, we compared the efficacy of TA with the MOA group. Our study revealed that terlipressin had a significant HRS reversal and 3-month survival rate compared to the combination of midodrine and octreotide. We could not compare the adverse effects between the two groups; however, studies have shown higher adverse events like abdominal cramps, arrhythmia with terlipressin. Fortunately, these side effects were transient and non-fatal. Few other advantages include low cost and ease of administration. We believe terlipressin could be of benefit over midodrine and octreotide, but this needs to be confirmed with bigger trials. Our study was limited as it included only one randomized control trial and had a small sample size.
Figure: Forest plot showing a comparison of reversal of renal failure status among terlipressin and albumin group over a combination of midodrine, octreotide, and albumin among cases of hepatorenal syndrome
Disclosures: Bhesh Karki indicated no relevant financial relationships. Dhan Shrestha indicated no relevant financial relationships. Pravash Budhathoki indicated no relevant financial relationships. Yub Raj Sedhai indicated no relevant financial relationships. Sanju Dahal indicated no relevant financial relationships. Anu Gautam indicated no relevant financial relationships. Samikshya Shukla indicated no relevant financial relationships.
Bhesh R. Karki, MD1, Dhan B. Shrestha, MD2, Pravash Budhathoki, MD3, Yub Raj Sedhai, MD4, Sanju Dahal, MBBS5, Anu Gautam, MBBS5, Samikshya Shukla, MBBS5. P0738 - Combination of Terlipressin and Albumin versus Combination of Midodrine, Octreotide, and Albumin in Hepatorenal Syndrome: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.