Carvedilol improves survival in patients with liver cirrhosis

  • McDowell HR & al.
  • Aliment Pharmacol Ther
  • 9 Dec 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This long-term follow-up study suggests that the use of carvedilol is associated with significantly improved survival in patients with liver cirrhosis and portal hypertension.

Why this matters

  • Findings add to a growing body of evidence to suggest that carvedilol is an advantageous pharmacological adjunct in patients with cirrhosis with portal hypertension.

Study design

  • This retrospective analysis included 152 patients with liver cirrhosis recruited to a multicentre randomised controlled trial between 2000 and 2006 and who were randomly assigned to receive carvedilol (n=77) or VBL (n=75) for the primary prophylaxis of oesophageal varices.
  • Primary outcome: all-cause mortality; secondary outcomes: liver-related mortality, transplant-free survival, and decompensation events (ascites, encephalopathy, variceal bleeding).
  • Funding: None.

Key results

  • In the intention-to-treat analysis, patients treated with carvedilol had significantly better survival vs those treated with VBL (median survival: 7.8 years vs 4.2 years; HR, 0.66; 95% CI, 0.45-0.96; P=.03).
  • This survival benefit was maintained in the per-protocol analysis with a median survival of 8.7 years in the carvedilol group vs 4.1 years in the VBL group (HR, 0.62; 95% CI, 0.40-0.96; P=.03).
  • No significant difference was observed between carvedilol and VBL groups in terms of:
    • liver-related mortality (median survival: 13 years vs 6.9 years; HR, 0.71; 95% CI, 0.44-1.15; P=.17);
    • transplant-free survival (median survival: 6.9 years vs 4.1 years; HR, 0.71; 95% CI, 0.48-1.04; P=.08);
    • time to first decompensation (HR, 0.75; 95% CI, 0.49-1.14; P=.16); and
    • time to ascites (HR, 0.77; 95% CI, 0.46-1.28; P=.31), encephalopathy (HR, 0.71; 95% CI, 0.40-1.25; P=.23) and variceal bleeding (HR, 1.12; 95% CI, 0.57-2.24; P=.73).

Limitations

  • Retrospective design.