TY - JOUR
T1 - Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome
T2 - A randomized trial
AU - for the Italian Association for the Study of the Liver Study Group on Hepatorenal Syndrome
AU - Cavallin, Marta
AU - Kamath, Patrick S.
AU - Merli, Manuela
AU - Fasolato, Silvano
AU - Toniutto, Pierluigi
AU - Salerno, Francesco
AU - Bernardi, Mauro
AU - Romanelli, Roberto Giulio
AU - Colletta, Cosimo
AU - Salinas, Freddy
AU - Di Giacomo, Antonio
AU - Ridola, Lorenzo
AU - Fornasiere, Ezio
AU - Caraceni, Paolo
AU - Morando, Filippo
AU - Piano, Salvatore
AU - Gatta, Angelo
AU - Angeli, Paolo
N1 - Publisher Copyright:
© 2015 by the American Association for the Study of Liver Diseases.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P=0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival. Conclusion: Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.
AB - Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P=0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival. Conclusion: Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.
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U2 - 10.1002/hep.27709
DO - 10.1002/hep.27709
M3 - Article
C2 - 25644760
AN - SCOPUS:84938201035
SN - 0270-9139
VL - 62
SP - 567
EP - 574
JO - Hepatology
JF - Hepatology
IS - 2
ER -