SPAIN: A recent study published in the journal The Lancet has found that in patients with compensated cirrhosis and CSPH (clinically significant portal hypertension) long-term treatment with β blockers could increase decompensation-free survival, mainly by reducing the incidence of ascites.
Clinical decompensation of cirrhosis is associated with poor prognosis. CSPH defined by a hepatic venous pressure gradient (HVPG) ≥10 mm Hg, is the strongest predictor of decompensation. Càndid Villanueva, University of Alcalá, Madrid, Spain, and colleagues conducted the study to assess whether lowering HVPG with β blockers could decrease the risk of decompensation or death in compensated cirrhosis with CSPH.
For the purpose, the researchers conducted a randomized, controlled trial in. 201 patients with compensated cirrhosis and CSPH without high-risk varices were included in this study on β blockers to prevent decompensation of cirrhosis with portal hypertension (PREDESCI). This investigation was carried out in eight hospitals in Spain. Incidence of cirrhosis decompensation (defined as development of ascites, bleeding, or overt encephalopathy) or death was the primary endpoint.
Participants were divided into a beta-blocker–responsive group (135 patients; defined as those who had a ≥10% drop in hepatic venous pressure gradient from baseline when given a propranolol infusion challenge) and a beta-blocker–nonresponsive group (66 patients). The responsive group was randomized to receive either propranolol or placebo and the nonresponsive group to either carvedilol or placebo. The primary endpoint was incidence of decompensation or death.
Key findings of the study include:
- During a median follow-up of 37 months, among the 100 patients who received beta-blockers, the rate of decompensation or death was significantly lower compared with the 101 patients who received placebo (16% vs. 27%).
- This difference was attributable to a significantly lower incidence of ascites.
- The overall incidence of adverse events including encephalopathy, hemorrhage, and mortality was similar in both groups. Six patients (four in the β blockers group) had severe adverse events.
“Findings suggested that long-term β-blocker treatment could increase decompensation-free survival in patients with compensated cirrhosis and CSPH, primarily by reducing ascites incidence,” concluded the authors.
For detailed study log on to https://doi.org/10.1016/S0140-6736(18)31875-0