Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study
Gut and Liver
;
: 702-710, 2017.
Article
in English
| WPRIM
| ID: wpr-175159
ABSTRACT
BACKGROUND/AIMS:
Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to propranolol therapy can improve hepatic venous pressure gradient (HVPG) response.METHODS:
Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint.RESULTS:
Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047).CONCLUSIONS:
Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Propranolol
/
Venous Pressure
/
Fibrosis
/
Pilot Projects
/
Decontamination
/
Interleukin-6
/
Tumor Necrosis Factor-alpha
/
Portal Pressure
/
Bacterial Translocation
/
Hypertension, Portal
Type of study:
Controlled clinical trial
Limits:
Humans
Language:
English
Journal:
Gut and Liver
Year:
2017
Type:
Article
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