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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Lessons from “real life experience” of rifaximin use in the management of recurrent hepatic encephalopathy
Fiona Chautant, Maeva Guillaume, Marie-Angèle Robic, Jean-François Cadranel, Jean-Marie Peron, Hortensia Lison, Charlène Cool, Christophe Bureau, Véronique Duhalde
Fiona Chautant, Service Pharmacie, Centre Hospitalier Universitaire de Toulouse, Hôpital Paule de Viguier, Toulouse 31059, France
Maeva Guillaume, Marie-Angèle Robic, Jean-Marie Peron, Christophe Bureau, Department of Hepato-Gastroenterology, University Hospital, Toulouse 31059, France
Jean-François Cadranel, Hortensia Lison, Department of Hepato-Gastroenterology, Laennec Hospital, Creil 60109, France
Charlène Cool, Department of Pharmacy and UMR INSERM 1027, University Hospital, Toulouse 31059, France
Véronique Duhalde, Department of Pharmacy, University Hospital Toulouse, Toulouse 31059, France
Author contributions: Chautant F was the guarantor of the article; Chautant F, Bureau C and Duhalde V designed the research study; all authors were involved with data collection or analysis; all authors were involved with data interpretation, drafting or offering critical revisions; Bureau C and Chautant F performed statistical analyses; all authors have read and approved the final manuscript.
Institutional review board statement: As a retrospective study, the approval of the ethics committee was not mandatory (i.e., according to the Jardé Law in France).
Informed consent statement: Informed consent was not required for this study. The data were collected anonymously.
Conflict-of-interest statement: Bureau C and Cadranel JF have conflicts of interest with Alpha Wassermann as speakers at a symposium and Norgine as consultants. The remaining authors disclose no conflict.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fiona Chautant, PhD, Pharmacist, Department of Pharmacy, University Hospital, 330 avenue de Grande Bretagne, Toulouse 31059, France. fiona.chautant@gmail.com
Received: July 1, 2019
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
BACKGROUND
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.
AIM
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”.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
