Takeaway
- Terlipressin is the most commonly prescribed vasoconstrictor for hospitalised patients with hepatorenal syndrome-acute kidney injury (HRS-AKI) in the UK, consistent with current guidelines.
- Initiation of terlipressin in patients with less severe AKI (serum creatinine [SCr] <2.25 mg/dL) is associated with higher rates of treatment response and 90-day survival.
Why this matters
- HRS and AKI are common complications of decompensated cirrhosis, and terlipressin is recommended as first-line vasoconstrictor therapy. However, there is a lack of data on its use outside of clinical trials.
Study design
- This multicentre chart review study included 225 patients diagnosed with HRS and treated by vasoconstrictor drugs at 26 hospitals in the UK.
- Primary outcome: improvement of kidney function, defined as complete response (SCr decreased to ≤1.5 mg/dL), partial response (SCr reduction of ≥20% but >1.5 mg/dL), and overall response (complete or partial response).
- Funding: Mallinckrodt Pharmaceuticals.
Key results
- 203 (90%) received terlipressin monotherapy with a median duration of 6 days (range, 2-24); mean SCr at vasopressor initiation was 3.25 ± 1.64 mg/dL.
- Overall and complete response rates were 73% and 50% in terlipressin-treated patients, respectively.
- Overall response rate was higher in patients with mild AKI (baseline SCr, <2.25 mg/dL; 79.1%) vs. those with moderate (SCr, ≥2.25 mg/dL and <3.5 mg/dL; 78.1%) and severe AKI (SCr, ≥3.5 mg/dL; 60.3%).
- In terlipressin-treated patients, 90-day survival was 92% at 1 month, 88% at 2 months, and 85% at 3 months.
- Adverse events were lower in patients treated with terlipressin vs those treated with other vasopressors (25% vs 41%).
Limitations
- Retrospective design.
Moore K, Jamil K, Verleger K, Luo L, Kebede N, Heisen M, Corman S, Leonardi R, Bakker R, Maï C, Shamseddine N, Huang X, Allegretti AS. Real-world treatment patterns and outcomes using terlipressin in 203 patients with the hepatorenal syndrome. Aliment. Pharmacol. Ther.2020 Jun 04 [Epub ahead of print]. doi: 10.1111/apt.15836. PMID: 32495956. Abstract.
This clinical summary first appeared on Univadis, part of the Medscape Professional Network.
