From Reuters Health Information
By David Douglas
NEW YORK (Reuters Health) Jan 30 - The usual three days of terlipressin treatment after ligation of bleeding esophageal varices could possibly be cut down to a single day, according to Pakistani researchers.
Overall, a 24-hour course of terlipressin was not inferior to 72 hours of treatment after endoscopic variceal band ligation (EVBL).
On the basis of this trial and a previous one, the researchers say they "may recommend shortening the duration of therapy in future guidelines."
However, Dr. Saeed S. Hamid added in an email to Reuters Health, until "others have had a chance to comment on it," he and his colleagues are not yet ready to suggest that the shorter course be the standard of care.
In a report online December 16th in the Journal of Hepatology, Dr. Hamid and colleagues note three to five days of vasoactive drugs are usually advised in addition to EVBL when varices bleed. However, the optimal duration in any given patient has not been established. Moreover, the team has found that particularly when the risk of rebleeding is low, 24 hours appears effective.
To investigate further, the researchers randomized 130 patients to receive terlipressin for 24 or 72 hours. Most patients were men and had hepatitis C virus infection. All had open-label terlipressin for the first 24 hours and then switched to active or dummy treatment.
Bleeding was controlled in everyone in the short-course group but there was one failure in the standard course group within 5 days. At 30 days, there was no difference in rebleeding rates, although the number in the control group was numerically lower: 3.1% and 1.5%.
At 30 days, there were 12 deaths from any cause (six in each group), and seven patients in each group reached the composite outcome of re-bleeding and/or death.
Overall, the short course was not inferior to longer term use.
If indeed the treatment could be safely shortened, Dr. Hamid said, there would be "significant cost implications, as well as perhaps implications on the safety of the drug without losing efficacy."
SOURCE: http://bit.ly/yYxQrf
J Hepatol 2011.
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