Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial.
Hepatology. 2015 Jan 16;
Authors: Cavallin M, Kamath PS, Merli M, Fasolato S, Toniutto P, Salerno F, Bernardi M, Romanelli RG, Colletta C, Salinas F, Di Giacomo A, Ridola L, Fornasiere E, Caraceni P, Morando F, Piano S, Gatta A, Angeli P, for the Italian Association for the Study of Liver (AISF) study group on HRS
Background: 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 is 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. Methods: Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group); 22 to receive midodrine and octreotide plus albumin (MID/OCT group). TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily with dose increased to a maximum of 12.5 mg tid, together with octreotide subcutaneously: initial dose 100 µg thrice daily, and up to 200 µg thrice daily. Both groups received albumin intravenously 1g/kg of body weight on day 1, and 20-40 g/day thereafter. Results: There was a significantly higher rate of recovery of renal function in TERLI group (19/27, 70.4%) as 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 (MELD) 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. This article is protected by copyright. All rights reserved.
PMID: 25644760 [PubMed - as supplied by publisher]