RESEARCH presented at the American College of Gastroenterology (ACG) 2024 Annual Meeting showed that rifaximin monotherapy (MT) significantly reduces the risk of recurring overt hepatic encephalopathy (OHE) and all-cause mortality in patients with cirrhosis compared to lactulose monotherapy.
Hepatic encephalopathy, a serious complication of liver disease, often prompts the use of lactulose as secondary prophylaxis after a first OHE episode. However, high non-adherence to lactulose, potentially triggering further OHE events, has led researchers to examine alternative treatment strategies. This analysis, based on data from two randomised clinical trials, explored the efficacy and safety of rifaximin MT versus lactulose MT in patients with a history of OHE.
The study evaluated 270 adult patients with cirrhosis and a history of OHE in remission. Patients were randomised into two groups: 125 received rifaximin MT, and 145 were treated with lactulose MT. Results revealed that only 23.2% of rifaximin-treated patients experienced an OHE recurrence, compared to 49.0% of those on lactulose, signifying a 60% reduction in recurrence risk with rifaximin. The number needed to treat (NNT) to prevent one recurrence was just four.
Additionally, rifaximin monotherapy yielded a notable survival benefit. The mortality rate in the rifaximin group was 1.6%, significantly lower than the 4.8% in the lactulose group, with an NNT of 19. Notably, rifaximin patients were less likely to discontinue the study prematurely (36% versus 62.1%), as fewer experienced OHE recurrence.
Overall, rifaximin MT was well-tolerated and proved a superior approach for managing OHE, especially in patients at higher risk for recurrence or non-adherence to lactulose. These findings suggest that rifaximin MT may serve as a viable alternative to lactulose MT for certain patient populations, offering both improved adherence and reduced mortality risk.
Reference
Bajaj JS et al. Rifaximin monotherapy is more effective than lactulose for reducing risk of overt hepatic encephalopathy (OHE) recurrence and all-cause mortality: an analysis of two randomized trials. ACG Annual Meeting, 25-30 October, 2024.
