Efficacy of vasopressin V2 receptor antagonist tolvaptan in treatment of hepatic edema.

Abstract

AIM:

Tolvaptan, an oral active vasopressin V2 receptor antagonist, is widely used for hepatic edema in Japan, but its clinical benefits have yet to be fully clarified. The present study evaluated the efficacy of tolvaptan in hepatic edema.

METHODS:

The efficacy and treatment regimen of tolvaptan were evaluated in 150 patients with hepatic edema by analyzing the initial (day 14) and long-term (day 90) responses to the drug and their predictive factors. All patients were divided into good (Child-Pugh classification B, and absent of advanced hepatocellular carcinoma) and poor hepatic condition groups, and the response rates were compared between the two groups.

RESULTS:

The initial response rate was 62%, and the long-term response rate was 47%. The assessment of predictive factors for response to tolvaptan showed that serum creatinine and C-reactive protein levels were important predictors of initial response, and that hepatic conditions, such as the Child-Pugh score or presence of hepatocellular carcinoma, as well as initial response, were significant predictors of long-term response. In addition, both the initial and long-term response rates and the cumulative survival rate were found to be higher in the good hepatic condition group than in the poor hepatic condition group, respectively (71% vs. 57%, P = 0.113; 62% vs. 39%, P = 0.009; log-rank test, P < 0.001).

CONCLUSION:

These results suggest that tolvaptan may provide high response rates when used early in the course of hepatic edema, or when both hepatic and renal functions are still retained, leading to an improved disease prognosis.

• Authors: Yasunari Hiramine, Hirofumi Uto, Yasushi Imamura, Takuya Hiwaki, Takeshi Kure, Sho Ijuin, Kohei Oda, Seiichi Mawatari, Kotaro Kumagai, Koki Tokunaga, Hirofumi Higashi, Ichiro Kanetsuki, Osamu Kubozono, Shigeho Maenohara, Akio Ido
• Journal: Hepatology research : the official journal of the Japan Society of Hepatology (Hepatol Res) Vol. 47 Issue 6 Pg. 542-557 (May 2017) ISSN: 1386-6346 [Print] Netherlands
• PMID: 27448501 (Publication Type: Journal Article)
• Copyright: © 2016 The Japan Society of Hepatology.