Response criteria of tolvaptan for the treatment of hepatic edema.

Abstract

BACKGROUND:

Although tolvaptan is an effective treatment for hepatic edema, there are no established criteria for assessment of the therapeutic effect. The present study evaluates the association between body weight change and clinical symptoms to identify an effective indicator of tolvaptan response.

METHODS:

The study comprised 460 patients. The first data set contained 147 patients with hepatic edema who received tolvaptan in Kagoshima Kouseiren Hospital, a representative institution of this study. From these data, an optimal cutoff value of body weight change, which accurately indicated symptom reduction, was identified. The response rates obtained based on the cutoff value were evaluated by receiver-operating characteristic (ROC) analysis and kappa coefficients. The kappa coefficient was then validated internally using the bootstrap method and externally using the validation data set of 313 patients from four other hospitals.

RESULTS:

A cutoff value for body weight loss of 1.5 kg/week produced the largest area under the ROC curve (0.961; sensitivity, 89.8%; specificity, 92.0%) and a high kappa coefficient (0.831). The correlation between symptom reduction and body weight loss of 1.5 kg/week was evaluated internally and externally, and the cutoff value was validated.

CONCLUSIONS:

The cutoff value of body weight change that most accurately reflected symptom reduction was 1.5 kg/week; this value is expected to be an effective indicator of response to tolvaptan in clinical practice.

• Authors: Yasunari Hiramine, Haruki Uojima, Hiroyuki Nakanishi, Akira Hiramatsu, Takuya Iwamoto, Mutsuumi Kimura, Hideto Kawaratani, Shuji Terai, Hitoshi Yoshiji, Hirofumi Uto, Isao Sakaida, Namiki Izumi, Kiwamu Okita, Kazuhiko Koike
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 53 Issue 2 Pg. 258-268 (Feb 2018) ISSN: 1435-5922 [Electronic] Japan
• PMID: 28664229 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antidiuretic Hormone Receptor Antagonists
• Tolvaptan

Topics

• Adult
• Aged
• Aged, 80 and over
• Antidiuretic Hormone Receptor Antagonists (administration & dosage, pharmacology, therapeutic use)
• Dose-Response Relationship, Drug
• Edema (drug therapy, physiopathology)
• Female
• Humans
• Liver Cirrhosis (drug therapy, physiopathology)
• Male
• Middle Aged
• ROC Curve
• Reproducibility of Results
• Retrospective Studies
• Severity of Illness Index
• Tolvaptan (administration & dosage, pharmacology, therapeutic use)
• Treatment Outcome
• Weight Loss (drug effects)
• Young Adult