Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy

S. H. Kang, Y. B. Lee, J. H. Lee, J. Y. Nam, Y. Chang, H. Cho, J. J. Yoo, Y. Y. Cho, E. J. Cho, S. J. Yu, M. Y. Kim, Y. J. Kim, S. K. Baik, J. H. Yoon

Research output: Contribution to journalArticle

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Abstract

Background: Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth. Aim: To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications. Methods: We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding. Results: In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P =.024) and reduced the risk of recurrent HE (aHR, 0.452; P <.001), SBP (aHR, 0.210; P <.001) and variceal bleeding (aHR, 0.425; P =.011) but not HRS (aHR, 0.598; P =.08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P =.121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P <.001) but not with variceal bleeding (aHR, 0.660; P =.104) or recurrent HE (aHR, 0.689; P =.057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P =.338). Conclusions: In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.

Original languageEnglish
Pages (from-to)845-855
Number of pages11
JournalAlimentary Pharmacology and Therapeutics
Volume46
Issue number9
DOIs
Publication statusPublished - 2017 Nov

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rifaximin
Hepatic Encephalopathy
Survival
Lactulose
Peritonitis
Hepatorenal Syndrome
Hemorrhage
Therapeutics
Clostridium difficile
Portal Hypertension
Hepatocellular Carcinoma
Diarrhea

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Kang, S. H. ; Lee, Y. B. ; Lee, J. H. ; Nam, J. Y. ; Chang, Y. ; Cho, H. ; Yoo, J. J. ; Cho, Y. Y. ; Cho, E. J. ; Yu, S. J. ; Kim, M. Y. ; Kim, Y. J. ; Baik, S. K. ; Yoon, J. H. / Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy. In: Alimentary Pharmacology and Therapeutics. 2017 ; Vol. 46, No. 9. pp. 845-855.
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title = "Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy",
abstract = "Background: Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth. Aim: To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications. Methods: We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding. Results: In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P =.024) and reduced the risk of recurrent HE (aHR, 0.452; P <.001), SBP (aHR, 0.210; P <.001) and variceal bleeding (aHR, 0.425; P =.011) but not HRS (aHR, 0.598; P =.08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P =.121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P <.001) but not with variceal bleeding (aHR, 0.660; P =.104) or recurrent HE (aHR, 0.689; P =.057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P =.338). Conclusions: In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.",
author = "Kang, {S. H.} and Lee, {Y. B.} and Lee, {J. H.} and Nam, {J. Y.} and Y. Chang and H. Cho and Yoo, {J. J.} and Cho, {Y. Y.} and Cho, {E. J.} and Yu, {S. J.} and Kim, {M. Y.} and Kim, {Y. J.} and Baik, {S. K.} and Yoon, {J. H.}",
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Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy. / Kang, S. H.; Lee, Y. B.; Lee, J. H.; Nam, J. Y.; Chang, Y.; Cho, H.; Yoo, J. J.; Cho, Y. Y.; Cho, E. J.; Yu, S. J.; Kim, M. Y.; Kim, Y. J.; Baik, S. K.; Yoon, J. H.

In: Alimentary Pharmacology and Therapeutics, Vol. 46, No. 9, 11.2017, p. 845-855.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy

AU - Kang, S. H.

AU - Lee, Y. B.

AU - Lee, J. H.

AU - Nam, J. Y.

AU - Chang, Y.

AU - Cho, H.

AU - Yoo, J. J.

AU - Cho, Y. Y.

AU - Cho, E. J.

AU - Yu, S. J.

AU - Kim, M. Y.

AU - Kim, Y. J.

AU - Baik, S. K.

AU - Yoon, J. H.

PY - 2017/11

Y1 - 2017/11

N2 - Background: Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth. Aim: To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications. Methods: We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding. Results: In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P =.024) and reduced the risk of recurrent HE (aHR, 0.452; P <.001), SBP (aHR, 0.210; P <.001) and variceal bleeding (aHR, 0.425; P =.011) but not HRS (aHR, 0.598; P =.08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P =.121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P <.001) but not with variceal bleeding (aHR, 0.660; P =.104) or recurrent HE (aHR, 0.689; P =.057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P =.338). Conclusions: In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.

AB - Background: Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth. Aim: To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications. Methods: We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding. Results: In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P =.024) and reduced the risk of recurrent HE (aHR, 0.452; P <.001), SBP (aHR, 0.210; P <.001) and variceal bleeding (aHR, 0.425; P =.011) but not HRS (aHR, 0.598; P =.08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P =.121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P <.001) but not with variceal bleeding (aHR, 0.660; P =.104) or recurrent HE (aHR, 0.689; P =.057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P =.338). Conclusions: In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.

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JF - Alimentary Pharmacology and Therapeutics

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