Rifaximin reduces hepatic encephalopathy after cirrhosis-related intervention
Article written by Bruce Sylvester
Researchers reported that patients treated with the antibiotic rifaximin before and after transjugular intrahepatic portosystemic shunt (TIPS) placement have achieved greater prevention of hepatic encephalopathy (HE) than those treated with a placebo.
The findings appeared on Feb. 1, 2021 in Annals of Internal Medicine.
In 2014 guidelines published in 2014 in the U.S. and Europe, there is no prophylactic therapy recommended to prevent overt hepatic encephalopathy after TIPS placement, which occurs in 35% – 50% of TIPS patients.
The researchers conducted a randomized, double-blind, multicenter, placebo-controlled trial, with a primary end point of incidence of overt hepatic encephalopathy within 168 days after the TIPS procedure.
They enrolled subjects with cirrhosis undergoing TIPS for intractable ascites or prevention of variceal rebleeding. They randomized the subjects to receive rifaximin (600 mg twice daily) or placebo, beginning 14 days before TIPS and continuing for 168 days afterwards.
They reported overt hepatic encephalopathy in 34% of subjects in the rifaximin group (n = 93) and 53% in the placebo group (n = 93).
Rates of other adverse events and transplant-free survival were not significantly different between the cohorts.
“In patients with cirrhosis treated with TIPS, rifaximin was well tolerated and reduced the risk for overt HE. Rifaximin should therefore be considered for prophylaxis of post-TIPS HE,” the authors concluded.
They added, “The study’s conclusion applies mainly to patients with alcoholic cirrhosis, who made up the study population. The potential benefit of rifaximin 6 months after TIPS and beyond remains to be investigated.”
