Gut Liver.  2017 Sep;11(5):702-710. 10.5009/gnl16478.

Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study

• Lim YL
• Kim MY
• Jang YO
• Baik SK
• Kwon SO

• KMID: 2389359
• DOI: http://doi.org/10.5009/gnl16478

Abstract

BACKGROUND/AIMS
Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to propranolol therapy can improve hepatic venous pressure gradient (HVPG) response.
METHODS
Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint.
RESULTS
Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047).
CONCLUSIONS
Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.

Keyword

Bacterial translocation; Rifaximin; Hypertension, portal; Hepatic venous pressure gradient

MeSH Terms

Bacterial Translocation
Decontamination
Fibrosis
Humans
Hypertension, Portal
Interleukin-6
Pilot Projects*
Portal Pressure*
Propranolol*
Tumor Necrosis Factor-alpha
Venous Pressure
Interleukin-6
Propranolol
Tumor Necrosis Factor-alpha