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Noradrenaline viable alternative to terlipressin for treating hepatorenal syndrome

Noradrenaline can be a safe and effective treatment for hepatorenal syndrome, according to recent results.

Researchers randomly assigned 46 patients with type 1 hepatorenal syndrome (HRS) to receive either terlipressin (n=23) or noradrenaline (n=23) with 20 g albumin daily for 15 days. Initial dosage in the terlipressin group was 0.5 mg intravenously every 6 hours, with a gradual increase every 3 days to a maximum of 2 mg every 6 hours if the patient proved unresponsive. Patients in the noradrenaline group received a continuous infusion of 0.5 mg/hour, with an increase of 0.5 mg/hour every 4 hours to a maximum of 3 mg/hour in the event of nonresponse. The rate of HRS reversal was determined for both groups, with a primary endpoint of serum creatinine levels less than 1.5 mg, and investigators also established potential predictive factors for response.

Nine patients (39.1%) in the terlipressin group experienced HRS reversal, compared with 10 (43.4%) in the noradrenaline group (P=.764). Univariate analysis indicated an association between treatment response and Child-Turcotte-Pugh (CTP) score at baseline, MELD score, urine output, albumin serum levels and mean arterial pressure, while only CTP maintained its association on multivariate analysis (P=.024).

Mortality rates were similar between the two groups, with 14 deaths in the terlipressin group at 15 days compared with 12 in the noradrenaline group (P>.05). Common causes of death included sepsis (n=14), liver failure (n=6) and multiple organ failures (n=5). Researchers did not observe any major adverse events as a result of either treatment. The cost of treatment was found to be significantly higher in the terlipressin group (P<.05).

“The results of this randomized study suggest that noradrenaline may be as effective and safe as terlipressin in the reversal of type 1 HRS in cirrhotics, but at a fraction of the cost,” the researchers wrote, “and baseline CTP score is a predictor of response. However, more studies are warranted to establish this drug as an alternate therapy.”