Durability of rifaximin response in hepatic encephalopathy.

Abstract

GOALS:

To evaluate the durability of the response to rifaximin for treatment of hepatic encephalopathy (HE).

BACKGROUND:

The nonsystemic antibiotic rifaximin has been approved for maintenance of HE remission, and several studies have indicated the efficacy of rifaximin for acute HE; however, the duration of therapeutic response for >6 months remains unknown.

STUDY:

Medical records of patients with cirrhosis who received rifaximin maintenance therapy for HE between January 2004 and May 2009 were reviewed. Model for end-stage liver disease (MELD) scores were obtained every 3 months during therapy.

RESULTS:

Of 203 patients with HE (Conn score ≥2), 149 received rifaximin monotherapy (400 to 1600 mg/d) and 54 received rifaximin (600 to 1200 mg/d) and lactulose (90 mL/d) dual therapy. Maintenance of HE remission for 1 year occurred in 81% and 67% of patients who received rifaximin monotherapy and rifaximin and lactulose dual therapy, respectively. Patient populations with a baseline mean MELD score ≤20 had few overt HE events, suggesting increased response to rifaximin in these patients.

CONCLUSIONS:

Rifaximin is effective for the management of HE in patients with cirrhosis, particularly in populations with MELD scores ≤20. Additional studies are needed to investigate the potential association between MELD scores and the efficacy of HE treatments.

• Authors: Guy W Neff, Michael Jones, Taylor Broda, Mark Jonas, Ravinuthala Ravi, David Novick, Tiffany E Kaiser, Nyingi Kemmer
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 46 Issue 2 Pg. 168-71 (Feb 2012) ISSN: 1539-2031 [Electronic] United States
• PMID: 22011586 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents
• Gastrointestinal Agents
• Rifamycins
• Lactulose
• Rifaximin

Topics

• Adult
• Aged
• Anti-Infective Agents (adverse effects, therapeutic use)
• Drug Therapy, Combination
• End Stage Liver Disease (drug therapy, physiopathology)
• Female
• Gastrointestinal Agents (therapeutic use)
• Hepatic Encephalopathy (drug therapy)
• Humans
• Lactulose (therapeutic use)
• Liver Cirrhosis (complications, drug therapy)
• Male
• Middle Aged
• Rifamycins (adverse effects, therapeutic use)
• Rifaximin
• Severity of Illness Index
• Time Factors