Terlipressin in hepatorenal syndrome: a systematic review and meta-analysis

Int Urol Nephrol. 2011 Mar;43(1):175-84. doi: 10.1007/s11255-010-9725-8. Epub 2010 Mar 20.

Abstract

Background: Hepatorenal syndrome (HRS) is a common complication in patients with cirrhosis or fulminant liver failure. We systematically reviewed the benefits and harms of using terlipressin, a novel vasoconstricting agent in patients with HRS.

Methods: We searched MEDLINE, SCOPUS, and conference proceedings for relevant trials of terlipressin. Results were summarized using the random-effects model.

Results: Eight trials (320 participants) were included. When compared with placebo, terlipressin-treated patients had higher HRS reversal (odds ratio [OR] 7.47, 95% confidence interval [CI] 3.17-17.59), mean arterial pressure (weighted mean difference [WMD] 11.26 mmHg, 95% CI 1.52-21), and urine output. There was a significant increase in ischemic adverse events with terlipressin when compared to placebo. There was mild-to-moderate heterogeneity in these analyses. There was no significant difference between terlipressin and noradrenaline in HRS reversal (OR 1.23, 95% CI, 0.43-3.54), mean arterial pressure, and urine output. Side-effect profile did not differ between terlipressin and noradrenaline.

Conclusion: Terlipressin improves HRS reversal and other surrogate outcome measures compared with placebo, but no significant differences for these outcomes were noted when comparing terlipressin and noradrenaline. Terlipressin is a potential therapeutic option for HRS, but larger trials comparing terlipressin to other widely used vasoconstrictors are warranted.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Diagnosis, Differential
  • Hepatorenal Syndrome* / diagnosis
  • Hepatorenal Syndrome* / drug therapy
  • Hepatorenal Syndrome* / etiology
  • Humans
  • Liver Cirrhosis / complications*
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Terlipressin
  • Treatment Outcome

Substances

  • Antihypertensive Agents
  • Lypressin
  • Terlipressin