Better prognosis among long-term responders treated with Tolvaptan for cirrhosis

In decompensated liver cirrhosis, long-term responders with water retention treated with tolvaptan without recurrence experienced significantly better prognosis, according to study results.

“Our data also suggested that obtaining a long-term response without recurrence might be important for achieving a good prognosis,” Masato Nakai, MD, from the department of gastroenterology and hepatology at Hokkaido University Graduate School of Medicine in Japan, said. “In the treatment of decompensated cirrhosis with water retention, the addition of treatments that control inflammation, such as intestinal sterilization and antibiotic therapy, may improve the patients’ prognosis.”

Researchers retrospectively assessed 100 patients with decompensated liver cirrhosis who received treatment with tolvaptan and used criteria from the EASL clinical practice guideline to evaluate recurrence. They performed an analysis on recurrence rate, prognosis of non-responders, patients with recurrence and long-term responders. Researchers also assessed baseline factors based on short-term response, recurrence and long-term response.

The assessment showed that 31% of short-term responders experienced recurrence. Significant factors of short-term response included low CRP levels and high urinary sodium/potassium ratios. Factors related to non-response included presence of acute kidney injury.

“Although there was no significant difference in the prognosis by short-term response (P = .07), the long-term responders had a significantly better prognosis than those with recurrence and non-responders (P < .01),” the investigators wrote.

Nakai and colleagues also reported that low CRP level (relapse < 1.10 mg/dL, long-term response < 0.94 mg/dL) was related to recurrence and long-term response.