ACG

ACG 2024: Rifaximin bests lactulose for prevention of hepatic encephalopathy recurrence

November 8, 2024

Rifaximin monotherapy is more effective than lactulose (LAC) monotherapy in reducing the risk of overt hepatic encephalopathy (OHE) recurrence and all-cause mortality in patients with cirrhosis, according to findings shared at the American College of Gastroenterology meeting.

In this post hoc analysis of two randomized phase 3 and 4 trials, researchers compared the efficacy and safety of LAC monotherapy vs. rifaximin monotherapy in adults with cirrhosis and a history of OHE. Only patients treated with rifaximin 550 mg bid (n = 125) or LAC (titrated to 2-3 soft stools/day) plus placebo (n = 145) were included in the analysis. The primary efficacy endpoint was time to first breakthrough OHE episode.

Key findings: Only 23.2% of patients on rifaximin experienced an OHE episode compared with 49.0% on LAC (P < 0.0001). Additionally, rifaximin reduced the risk of breakthrough OHE by 60% and was associated with a lower mortality rate than LAC (1.6% vs. 4.8%; P < 0.001). Number needed to treat (NNT) for preventing one OHE episode was 4, and for preventing one death was 19. More LAC-treated vs. rifaximin-treated patients discontinued early from study (62.1% vs 36.0%), most commonly due to HE recurrence.

Source:

Bajaj, J., et al. (2024, October 28). Rifaximin Monotherapy Is More Effective Than Lactulose Monotherapy for Reducing the Risk of Overt Hepatic Encephalopathy (OHE) Recurrence and All-Cause Mortality: An Analysis of Two Randomized Trials. Presented at the American College of Gastroenterology. https://acg2024.eventscribe.net/fsPopup.asp?PresentationID=1498097&mode=presInfo