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Propranolol/rifaximin combo reduces hepatic venous pressure gradient in patients with cirrhosis

VIENNA — Gut decontamination combination therapy with propranolol and rifaximin greatly reduced hepatic venous pressure gradient in patients with cirrhosis vs. propranolol monotherapy, according to data presented at the 2015 International Liver Congress.

“Propranolol and rifaximin combination therapy showed additive effect in the reduction of HVPG,” Soon Koo Baik, MD, PhD, of the department of internal medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Korea, said during his presentation. “Addition of rifaximin can be a good solution to break the limitations of non-selective beta blocker.”

Researchers randomly assigned 65 patients with advanced cirrhosis to undergo either propranolol monotherapy (n = 48) or propranolol and rifaximin combination therapy (n = 17). In the propranolol group, propranolol was dosed to a maximum of 320 mg per day with a goal of a 25% heart rate reduction. In the combination therapy group, propranolol was dosed according to heart rate, limited to 160 mg per day, and 1200 mg of rifaximin per day. Mean blood pressure, hepatic venous pressure gradient (HVPG) and other data were collected at baseline and at the end of the 3-month treatment period. The goal of the study was to determine any benefit of added therapy with rifaximin on HVPG.

Overall, portal pressure declined in both the monotherapy group (17.0 ± 3.9 mmHg to 13.5 ± 4.1 mmHg) and combination therapy group (16.7 ± 3.6 mmHg to 10.9 ± 4.7 mmHg; P < .001). Patients in the combination therapy group had a better HVPG response rate (82.4% vs. 50%; P = .018) and a larger mean reduction in HVPG (5.8 ± 3.8 mmHg vs. 3.5 ± 3.9 mmHg; P = .038) compared to the monotherapy group.   

Changes of bacterial translocation markers were more significant in the combination therapy group compared with the monotherapy group, according to Baik’s presentation.

In addition, the mean dose of propranolol and heart rate reduction were smaller in the combination group compared with the monotherapy group (P = .033, P = .001), according to the abstract. – by Melinda Stevens

For More Information:

Baik SK. Abstract G03. Presented at: International Liver Congress; April 22-26, 2015; Vienna.

Disclosure: The researchers report no relevant financial disclosures.