Rifaximin vs. conventional oral therapy for hepatic encephalopathy: a
meta-analysis.
Author(s): Eltawil KM, Laryea M, Peltekian K, Molinari M.
Affiliation(s): Department of Surgery and Transplantation, Queen Elizabeth II Health Sciences
Center, Dalhousie University, Halifax, Nova Scotia B3H 2Y9, Canada.
Publication date & source: 2012, World J Gastroenterol. , 18(8):767-77
AIM: To characterize the efficacy of rifaximin in the management of hepatic
encephalopathy (HE) as several randomized controlled studies have shown
contradictory results on its effectiveness in comparison to other oral agents.
METHODS: We performed a systematic review and random effects meta-analysis of all
eligible trials identified through electronic and manual searches. Twelve
randomized controlled trials met the inclusion criteria with a total of 565
patients.
RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides
or other oral antibiotics [odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a
better safety profile (OR 0.27; 95% CI: 0.12-0.59). At the completion of
treatment protocols, patients receiving rifaximin showed lower serum ammonia
levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10],
better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less
asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical
significance. On the other hand, other psychometric outcomes such as
electroencephalographic response and grades of portosystemic encephalopathy were
superior in patients treated with rifaximin in comparison to the control group
(WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98,
P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any
significant difference in the above findings.
CONCLUSION: Rifaximin appears to be at least as effective as other conventional
oral agents for the treatment of HE with a better safety profile.
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