medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2014, Number 4

<< Back Next >>

Ann Hepatol 2014; 13 (4)

Hemodynamic effect of carvedilol vs. propranolol in cirrhotic patients: Systematic review and meta-analysis

Aguilar-Olivos N, Motola-Kuba M, Candia R, Arrese M, Méndez-Sánchez N, Uribe M, Chávez-Tapia NC

Language: English
References: 24
Page: 420-428
PDF size: 112.71 Kb.


ABSTRACT

Background. Carvedilol appears to be more effective than propranolol in the treatment of portal hypertension in cirrhotic patients. Aim. To compare the effects of carvedilol vs. propranolol on systemic and splanchnic haemodynamics and to evaluate the adverse events associated with these treatments. Material and methods. We performed a systematic review following the Cochrane and PRISMA recommendations. Randomised controlled trials comparing carvedilol versus propranolol, in the treatment of portal hypertension in cirrhotic patients with oesophageal varices, with or without bleeding history were included. The primary outcome measure was the haemodynamic response to treatment. Results. Four randomised trials and 153 patients were included; 79 patients received carvedilol (6.25-50 mg/d) and 74 patients received propranolol (10-320 mg/d). The hepatic vein pressure gradient (HVPG) decreased more with carvedilol than with propranolol (MD –2.21; 95% CI: –2.83 to –1.60, I2 = 0%, P ‹ 0.00001). Carvedilol was superior to propranolol for reducing HVPG by ≥ 20% from the baseline value or to ≤ 12 mmHg (OR: 2.93; 95% CI: 1.50 to 5.74, I2 = 22%, P = 0.002). Overall adverse events did not differ between. In conclusion, there is limited evidence suggesting that carvedilol is more effective than propranolol for improving the haemodynamic response in cirrhotic patients with portal hypertension. Long-term randomized controlled trials are needed to confirm this information.


REFERENCES

  1. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-51.

  2. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44: 217-31.

  3. Minano C, Garcia-Tsao G. Clinical pharmacology of portal hypertension. Gastroenterol Clin North Am 2010; 39: 681-95.

  4. Addley J, Tham TC, Cash WJ. Use of portal pressure studies in the management of variceal haemorrhage. World J Gastrointest Endosc 2012; 4: 281-9.

  5. Casado M, Bosch J, Garcia-Pagan JC, Bru C, Bańares R, Bandi JC, Escorsell A, et al. Clinical events after transjugular intrahepatic portosystemic shunt: correlation with hemodynamic findings. Gastroenterology 1998; 114:1296-1303

  6. D’Amico G. Esophageal varices: from appearance to rupture; natural history and prognostic indicators. In: Groszmann R, Bosch J (eds.). Portal Hypertension in the 21st Century: Dordrecht: Kluwer Academic; 2004, p. 147-54.

  7. Groszmann RJ, Garcia-Tsao G, Bosch J, Grace ND, Burroughs AK, Planas R, Escorsell A, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med 2005; 353: 2254-61.

  8. Merli M, Nicolini G, Angeloni S, Rinalidi V, De Santis A, Merkel C, Attili AF, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 2003; 38: 266-72.

  9. D’Amico G, Luca A. Natural history. Clinical-haemodynamic correlations. Prediction of the risk of bleeding. Baillieres Clin Gastroenterol 1997; 11: 243-56.

  10. D’Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 1999; 19: 475-505.

  11. de Franchis R. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762-8.

  12. Groszmann RJ, Bosch J, Grace ND, Conn HO, Garcia-Tsao G, Navasa M, Alberts J, et al. Hemodynamic events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 1990; 99: 1401-7.

  13. Feu F, Garcia-Pagan JC, Bosch J, Luca A, Terés J, Escorsell A, Rodés J, et al. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal haemorrhage in patients with cirrhosis. Lancet 1995; 346: 1056-9.

  14. Bańares R, Moitinho E, Piqueras B, Casado M, García-Pagán JC, de Diego A, Bosch J. Carvedilol, a new nonselective beta-blocker with intrinsic anti- Alpha1-adrenergic activity, has a greater portal hypotensive effect than propranolol in patients with cirrhosis. Hepatology 1999; 30: 79-83.

  15. De BK, Das D, Sen S, Biswas PK, Mandal SK, Majumdar D, Maity AK. Acute and 7-day portal pressure response to carvedilol and propranolol in cirrhotics. J Gastroenterol Hepatol 2002; 17: 183-9.

  16. Banares R, Moitinho E, Matilla A, García-Pagán JC, Lampreave JL, Piera C, Abraldes JG, et al. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 2002; 36: 1367-73.

  17. Hobolth L, Moller S, Gronbaek H, Roelsgaard K, Bendtsen F, Feldager Hansen E. Carvedilol or propranolol in portal hypertension? A randomized comparison. Scand J Gastroenterol 2012; 47: 467-74.

  18. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151: 264-9, W264.

  19. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]: The Cochrane Collaboration, 2011.

  20. Tripathi D, Therapondos G, Lui HF, Stanley AJ, Hayes PC. Haemodynamic effects of acute and chronic administration of low-dose carvedilol, a vasodilating beta-blocker, in patients with cirrhosis and portal hypertension. Aliment Pharmacol Ther 2002; 16: 373-80.

  21. Stanley AJ, Therapondos G, Helmy A, Hayes PC. Acute and chronic haemodynamic and renal effects of carvedilol in patients with cirrhosis. J Hepatol 1999; 30:479-84.

  22. Sinagra E, D’Amico M, Perricone G. Carvedilol compared to propranolol for portal hypertension in cirrhosis. Abstracts of the A.I.S.F. Annual Meeting 2010 / Digestive and Liver Disease 2011; 43S:S73

  23. Razon-Gonzalez EV, Tripon E, Forroza R. Carvedilol vs propranolol in portal hypertension: a meta-analysis. Hepatol Int 2012; 6: 305.

  24. Reiberger T, Ulbrich G, Ferlitsch A, Payer BA, Schwabl P, Pinter M, Heinisch BB, et al. Carvedilol for primary prophylaxis of variceal bleeding in cirrhotic patients with haemodynamic non-response to propranolol. Gut 2012; 62 1634-41.




2020     |     www.medigraphic.com