This article is more than 5 years old. Information may no longer be current.

Carvedilol reduced risk of mortality in patients with cirrhosis, mild ascites

Long-term carvedilol therapy in patients with liver cirrhosis and ascites was associated with reduced risk of mortality, according to a single-center retrospective analysis.

“We have shown that long-term use of low dose carvedilol in cirrhosis with ascites was associated with reduced risk of mortality,” the researchers wrote. “This association was modified by the severity of ascites; carvedilol therapy was associated with decreased risk of death in mild ascites but did not affect the outcomes of those with moderate or severe ascites. Importantly, even in the presence of severe ascites, carvedilol therapy was not associated with excess mortality.”

Rohit Sinha, M BBS, MRCP, PgDip , and colleagues analyzed 264 patients treated for cirrhosis and ascites at the Liver Unit at The Royal Infirmary of Edinburgh between Jan. 1, 2009, and Aug. 31, 2012.

Patient median age was 59.5 years and 67% were men. Half of the patients were treated with carvedilol therapy. The median dose for the carvedilol group was 12.5 mg daily (range, 6.25-12.5 mg). Twelve patients discontinued therapy within the first year, while 106 continued therapy until the end of follow-up (median 2.2 years).

The two groups had comparable etiology for liver disease, previous variceal bleed, severity of ascites, antibiotic for spontaneous bacterial peritonitis (SBP) prophylaxis, serum sodium, serum creatinine, serum albumin, serum total bilirubin, international normalized ratio, United Kingdom Model for End-Stage Liver Disease (UKELD) score and MELD. Severity of ascites was noted as either mild (43.3%), moderate (32.2%) or severe (23.5%).

The survival rate for the carvedilol group was 95% at 6 months and 61% at 2 years, compared with the non-carvedilol group’s survival rates of 89% at 6 months and 47% at 2 years. At the end of follow-up, the survival rate was 24% for the carvedilol group and 2% for the non-carvedilol group. (P = .001).

After adjusting for age, gender, etiology of cirrhosis, previous variceal bleed, SBP prophylaxis, serum albumin and UKELD, patients in the carvedilol group with mild ascites had a 43% reduction in risk of mortality (HR 0.47; 95% CI, 0.29-0.77). Those with moderate and severe ascites did not reap the same benefits with mortality rates similar between groups.

“Although the risk of death in moderate and severe ascites was statistically similar between carvedilol and non-carvedilol group, the trend was that the impact of carvedilol decreased with increasing severity of ascites. This is consistent with the ‘therapeutic window hypothesis’ which stipulates that NSBB therapy may be effective only within a particular clinical window of advanced liver disease,” the researchers wrote.

– by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.