Various vasoconstrictors have shown promising results in the management of type 1 hepatorenal syndrome (HRS). However, there are very few studies on vasopressors in the management of type 2 HRS. Terlipressin has been used commonly; however it is costly and not available in some countries. In the present study, the investigators evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of type 2 HRS
Background: Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS. Methods: Sixty patients with HRS were managed with terlipressin (group A, N = 30) or noradrenaline (group B, N = 30) with albumin for a maximum of 15 days in a randomized controlled trial at a tertiary centre. Results: Baseline parameters were similar in both groups.HRS reversal could be achieved in 18 (60%) patients in group A and 17 (56%) patients in group B (p=0.85). Patients in both groups had a significant decrease in serum creatinine (group A, 2.36± 0.57 vs 1.33±0.41 mg/dL; group B, 2.48± 0.58 vs 1.45±0.5 mg/dL), increase in urine output (group A, 686.83±268.67 vs 1289.76±344.25 ml/24 hr; group B, 699.67±275.63 vs 1242.50±313.90 ml/24hr) and natriuresis (group A, 55.60±17.87 vs 80.45±14.87 meq/ 24 hr; group B, 51.20±15.73 vs 76.20±18.40 meq/24 hr) at day 15 (p <0.05). Nine patients in group A and 10 in group B died at day 15 (p > 0.05). Noradrenaline was less expensive than terlipressin (Rs.10400 vs 26301; p<0.05). No major adverse effects were seen. Conclusions: Noradrenaline is as safe and effective as terlipressin and less expensive than terlipressin in the treatment of HRS.
BACKGROUND & AIMS: Various vasoconstrictors are useful in the management of hepatorenal syndrome (HRS). Terlipressin is the drug of choice; however, it is expensive. In this study, we evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of HRS.
METHODS: Forty-six patients with HRS type 1 were managed with terlipressin (group A, N=23) or noradrenaline (Group B, N=23) with albumin in a randomized controlled trial at a tertiary center.
RESULTS: HRS reversal could be achieved in 9 (39.1%) patients in group A and 10 (43.4%) patients in group B (p=0.764). Univariate analysis showed baseline Child Turcotte Pugh score (CTP), model of end stage liver disease (MELD), urine output on day 1(D1), albumin, and mean arterial pressure (MAP) were associated with response. However, on multivariate analysis only CTP score was associated with response. Fourteen patients in group A and 12 in group B died at day 15 (p>0.05). Noradrenaline was less expensive than terlipressin (p<0.05). No major adverse effects were seen.
CONCLUSIONS: The results of this randomized study suggest that noradrenaline is as safe and effective as terlipressin, but less expensive in the treatment of HRS and baseline CTP score is predictive of response.
Various vasoconstrictors have shown promising results in the management of type 1 hepatorenal syndrome (HRS). However, there are very few studies on vasopressors in the management of type 2 HRS. Terlipressin has been used commonly; however it is costly and not available in some countries. In the present study, the investigators evaluated safety and efficacy of terlipressin and noradrenaline in the treatment of type 2 HRS
