Published online Jan 27, 2020. doi: 10.4254/wjh.v12.i1.10
Peer-review started: July 1, 2019
First decision: August 7, 2019
Revised: September 30, 2019
Accepted: December 8, 2019
Article in press: December 8, 2019
Published online: January 27, 2020
Hepatic encephalopathy (HE) is a major complication of cirrhosis with independent prognostic significance. The current management of HE is mainly based on lactulose. Rifaximin has been shown to decrease the risk of HE recurrence in patients with episodic forms. HE can also be persistent. However, there is no drug support recommendation for rifaximin use in this setting.
To assess the effectiveness of rifaximin in the management of recurrent episodes of HE and recurrent acute exacerbations on persistent HE, in “real life conditions”.
In this retrospective study, using a within-subjects design, we collected data of patients treated with rifaximin for HE in two liver diseases centers, during the six-month period before and during the six-month period after the initiation of rifaximin. The primary effectiveness endpoint was the total number of HE events involving hospitalization.
Rifaximin was introduced for prevention of recurrent HE episodes in 29 out of 62 patients with normal mental status between episodes and for prevention of recurrent acute exacerbations on persistent HE in 33 out of 62 patients. In the “prevention of recurrent HE episodes” group, fewer HE events (0.79 vs 1.78; P = 0.013) were reported during the period of time when rifaximin was used. In the “prevention of recurrent acute exacerbations on persistent HE” group, there was no significant difference in the number of HE-events (1.48 vs 1.77; P = 0.582).
In this real-life experience, the effectiveness of rifaximin was confirmed in the prevention of HE episodes recurrence but was not proved in the prevention of acute exacerbations recurrence on persistent HE.
Core tip: The clinical and economic burdens of hepatic encephalopathy (HE) are tremendous and growing worldwide. Therapies to improve the quality of life of patients and to decrease the rate of hospitalizations and economic consequences are needed. Rifaximin was proved effective to reduce the risk of HE recurrence in patients with episodic forms. However, real-life data are still scarce, particularly concerning persistent HE. In this real-life experience, the effectiveness of rifaximin was confirmed in the prevention of HE episodes recurrence but was not proved in the management of persistent HE.