Compensated liver cirrhosis: Natural course and disease-modifying strategies

Table 3 Impact of non-selective beta-blockers on portal hypertension, variceal haemorrhage, decompensation, and survival in patients with liver cirrhosis

Ref.	Study population	Intervention	Study design	Sample size, n	Study conclusion
Poynard et al[70], 1991	LC patients with oesophageal varices	Propranolol, nadolol vs placebo	Meta-analysis of 4 RCTs	589	Both propranolol and nadolol were effective in preventing first VH and reducing the mortality associated with VH
Tripathi et al[71], 2009	LC patients with grade II or more varices	Carvedilol vs EVL	RCT	152	On intention-to-treat analysis, carvedilol had lower rates of the first VH compared to EVL (10% vs 23%)
Gluud et al[69], 2012	LC patients with high-risk varices without prior VH	NSBBs vs EVL	Meta-analysis of 19 RCTs	1504	Both EVL and NSBB reduced VH (RR: 0.69 and 0.67) without difference in mortality rates
Sinagra et al[75], 2014	LC patients with PHT	Carvedilol vs propranolol	Meta-analysis of 5 studies	175	Carvedilol reduced PHT significantly more than propranolol
Bhardwaj et al[76], 2017	LC patients with small varices	Carvedilol vs placebo	RCT	140	Carvedilol is safe and effective in delaying the progression of small to large oesophageal varices in LC patients
Zacharias et al[77], 2018	Adults with LC and varices	NSBBs	Meta-analysis of 10 RCTs	810	Carvedilol was more effective at reducing the HVPG. However, it was not better than traditional NSBBs with regard to the mortality, VH, or adverse events
Malandris et al[72], 2019	LC patients requiring primary or secondary prevention of VH	Carvedilol, NSBBS, EVL	Meta-analysis of 13 RCTs	1598	Carvedilol was as efficacious and safe as standard-of-care interventions for the primary and secondary prevention of VH. Also, carvedilol was associated with lower all-cause mortality compared to EVL
Sharma et al[73], 2019	LC patients with large oesophageal varices and no prior history of VH	NSBB, isosorbide-mononitrate, carvedilol, and EVL alone or in combination	Meta-analysis of 32 RCTs	3362	NSBB monotherapy decreased all-cause mortality and the risk of first VH. Additionally, NSBB carried a lower risk of serious complications compared with EVL
Villanueva et al[22], 2019	CLC patients and CSPH	Propranolol, carvedilol vs placebo	RCT	201	Long-term treatment with β blockers could increase decompensation-free survival in patients with CLC with CSPH, mainly by reducing the incidence of ascites
Villanueva et al[78], 2022	LC patients with CSPH	Carvedilol vs EVL/no treatment	Meta-analysis of 4 RCTs	352	Long-term carvedilol therapy reduced decompensation and significantly improved survival

CLC: Compensated liver cirrhosis; CSPH: Clinically significant portal hypertension; EVL: Endoscopic variceal ligation; HVPG: Hepatic venous portal gradient; LC: Liver cirrhosis; NSBBs: Non-selective beta-blockers; PHT: Portal hypertension; RCT: Randomised controlled trial; RR: Relative risk; VH: Variceal haemorrhage.