AASLD 2019 — Rifaximin reduces hepatic encephalopathy risk after TIPS


  • Brandon May
  • Conference Reports
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Takeaway

  • Twice-daily rifaximin reduces the risk of hepatic encephalopathy (HE) and is associated with a higher rate of transplant-free survival during a 6-month period after placement of a transjugular intrahepatic portosystemic shunt (TIPS).

Why this matters

  • More effective strategies are needed to prevent HE, a common complication after creation of a TIPS.

Study design

  • A total of 144 men and 44 women (mean age, 59.9±9 years) who were treated with TIPS were included in the trial.
  • Approximately 20% of patients had experienced ≥1 episode of HE prior to TIPS.
  • Patients were randomly assigned to either twice-daily rifaximin 600 mg or placebo, initiated 15 days prior to TIPS and for 6 months following the procedure. 
  • The probability of remaining free of HE at 6 months comprised the primary endpoint. 
  • Funding: None reported.

Key results

  • Mean follow-up period: 310±120 days.
  • The primary endpoint was met in 59.1% (95% CI, 49.8-70.2) of patients in the rifaximin group vs 44.2% (95% CI, 34.9-56.1) in the placebo group (P=.05).
  • At 6 months, the transplant-free survival rate was 93.2% (95% CI, 88.0-98.6) in the rifaximin group vs 84.0% (95% CI, 76.7-92.1) in the placebo group.

Limitations

  • The study included more men than women.