Rifaximin and propranolol combination therapy is more effective than propranolol monotherapy for the reduction of portal pressure: An open randomized controlled pilot study

Yoo Li Lim, Moon Young Kim, Yoon Ok Jang, Soon Koo Baik, Sang Ok Kwon

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Background/Aims: Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to pro-pranolol therapy can improve hepatic venous pressure gradient (HVPG) response. Methods: Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-Treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint. Results: Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047). Conclusions: Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.

Original languageEnglish
Pages (from-to)702-710
Number of pages9
JournalGut and liver
Volume11
Issue number5
DOIs
Publication statusPublished - 2017 Sep

Bibliographical note

Funding Information:
This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C2364), and also by the Yonsei University Future-Leading Research Initiative of 2014. It was also supported by The Academic Scholarship of the Korean Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Fingerprint Dive into the research topics of 'Rifaximin and propranolol combination therapy is more effective than propranolol monotherapy for the reduction of portal pressure: An open randomized controlled pilot study'. Together they form a unique fingerprint.

Cite this