Terlipressin versus Norepinephrine in the Treatment of Hepatorenal Syndrome: A Systematic Review and Meta-Analysis

Background: Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS. Methods: We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events. Results: Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83). Conclusions: Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.

URI

https://observatorio.fm.usp.br/handle/OPI/8451

Referências

Alessandria C, 2007, J HEPATOL, V47, P499, DOI 10.1016/j.jhep.2007.04.010
Angeli P, 2012, J HEPATOL, V57, P1135, DOI 10.1016/j.jhep.2012.06.024
Arroyo V, 2011, NAT REV NEPHROL, V7, P517, DOI 10.1038/nrneph.2011.96
Arroyo V, 1996, HEPATOLOGY, V23, P164, DOI 10.1002/hep.510230122
Carvalho Grazielle Cerqueira de, 2012, Ann Hepatol, V11, P90
Dobre M, 2011, INT UROL NEPHROL, V43, P175, DOI 10.1007/s11255-010-9725-8
Duvoux C, 2002, HEPATOLOGY, V36, P374, DOI 10.1053/jhep.2002.34343
Ghosh S, 2013, LIVER INT, V33, P1187, DOI 10.1111/liv.12179
GINES A, 1993, GASTROENTEROLOGY, V105, P229
Gluud LL, 2012, COCHRANE DB SYST REV, V9, DOI 10.1002/14651858.CD005162.PUB3
Higgins Julian P T, 2011, BMJ, V343, pd5928, DOI 10.1136/bmj.d5928
Hiremath SB, 2013, INDIAN J PHARMACOL, V45, P54, DOI 10.4103/0253-7613.106436
Kiszka-Kanowitz M, 2004, SCAND J GASTROENTERO, V39, P486, DOI 10.1080/00365520310008728
Liberati A, 2009, BMJ-BRIT MED J, V339, DOI 10.1136/bmj.b2700
Martin-Llahi M, 2008, GASTROENTEROLOGY, V134, P1352, DOI 10.1053/j.gastro.2008.02.024
Narahara Y, 2009, J GASTROEN HEPATOL, V24, P1791, DOI 10.1111/j.1440-1746.2009.05873.x
Nazar A, 2010, HEPATOLOGY, V51, P219, DOI 10.1002/hep.23283
Salerno F, 2011, J HEPATOL, V55, P1241, DOI 10.1016/j.jhep.2011.03.012
Salerno F, 2007, GUT, V56, P1310, DOI 10.1136/gut.2006.107789
Sanyal AJ, 2008, GASTROENTEROLOGY, V134, P1360, DOI 10.1053/j.gastro.2008.02.014
Sharma P, 2008, AM J GASTROENTEROL, V103, P1689, DOI 10.1111/j.1572-0241.2008.01828.x
Singh V, 2012, J HEPATOL, V56, P1293, DOI 10.1016/j.jhep.2012.01.012
Wallace BC, 2009, BMC MED RES METHODOL, V9, DOI 10.1186/1471-2288-9-80

Coleções

Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/07
Artigos e Materiais de Revistas Científicas - LIM/08
Artigos e Materiais de Revistas Científicas - LIM/37
Artigos e Materiais de Revistas Científicas - ODS/03

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