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Shorter terlipressin regimen may effectively treat esophageal variceal bleeding

A 24-hour terlipressin treatment was as effective for patients with esophageal variceal bleeding as the recommended 72-hour regimen in a recent study.

Researchers randomly assigned 130 patients with cirrhosis, hematemesis and/or melena and esophageal variceal bleeding (EVB) to receive terlipressin for either 24 hours (n=65) or 72 hours (n=65). All participants had received successful endoscopic variceal band ligation (EVBL) prior to enrollment. Evaluated factors included failure to control bleeding, 30-day mortality and recurrence of bleeding.

Terlipressin failed to control bleeding in only one patient in the 72-hour group, because of death from myocardial infarction during the 2-year study. No significant difference was observed in bleeding control between the two groups (P=.5). One 72-hour participant and two 24-hour participants experienced rebleeding within 30 days (P=.5), with a mean bleeding-free survival of 29.8 days in the 72-hour group and 29.5 days in the 24-hour group (P=.285). Six patients from each group died during the study of any cause (P=.5), with a mean survival rate of 28.4 days in the 72-hour group and 28.2 days in the 24-hour group (P=.495).

“Our study shows that [a 24-hour] terlipressin treatment is non-inferior to [a 72-hour] terlipressin treatment in acute EVB, as adjuvant therapy to successful EVBL,” the researchers wrote, but noted that a larger cohort or meta-analysis would be necessary to more definitively confirm these results. “This trial has clinical implications of cost savings and may help shorten the length of hospital stay in clinical practice and probably will be associated with fewer side effects.”