Q&A: Rifaximin plus or minus lactulose reduces ED visits for hepatic encephalopathy
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Rifaximin plus or minus lactulose compared with lactulose alone correlated with a decrease in ED health care utilization in patients with hepatic encephalopathy, according to a presentation at the ACG Annual Scientific Meeting.
Healio Gastroenterology spoke with Michael Volk, MD, professor and division head of the gastroenterology and hepatology department at Loma Linda University in Loma Linda, California, on the study’s key results and future steps in research.
Healio: What was the purpose and design of the study?
Volk: The purpose was to look at real world experience with Rifaximin. We know that rifaximin in other randomized trials associated with fewer episodes of hepatic encephalopathy (HE) and fewer hospitalizations, but it's unknown whether in the real world the use of rifaximin would be associated with decreased healthcare utilization overall including ED visits.
Healio: What were some of the key takeaways from this study?
Volk: We looked at two datasets and we looked at treatment episodes in patients treated with lactulose alone vs. rifaximin plus or minus lactulose. We found that overall, patients on rifaximin had lower rates of ED visits than patients on lactulose alone and those rates varied based on the database. In the MarketScan database (IBM) there was a 25% decrease in the number of days with ED visits. For the Clinformatics Data Mart database (Optum Inc.) there was an 18% decrease.
Healio: What was the main conclusion of this study?
Volk: The use of Rifaximin plus or minus lactulose vs. lactulose alone is associated with decreased ED and health care utilization.
Healio: What is the next step in research?
Volk: There's another side analysis that we did and that's because people argued that lactulose is not very well tolerated, patients don't like it and there are a lot of side effects. Adherence is not always great. We looked at treatment episodes where there was high adherence to see if this difference held true and it did, even in patients that are very adherent to their medication. Rifaximin was still associated with lower rates of ED visits. The next step in research is to find out the extent to which long term use of Rifaximin reduces rates of hepatic encephalopathy, hospitalizations and ED visits, and is associated with better overall health outcomes.
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Volk M. Poster: P1788. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
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