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Meta-Analysis
. 2016 May 4;6(5):e010902.
doi: 10.1136/bmjopen-2015-010902.

Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis

Tong Li  1 , Wenbo Ke  1 , Ping Sun  1 , Xiang Chen  1 , Ajay Belgaumkar  2 , Yuanjian Huang  1 , Wenjing Xian  3 , Jinjin Li  1 , Qichang Zheng  1
Affiliations
Meta-Analysis

Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis

Tong Li et al. BMJ Open. .

Abstract

Objective: To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension.

Design: A systematic review and meta-analysis.

Data sources: We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015. Only randomised controlled trials (RCTs) were included.

Outcome measure: We calculated clinical outcomes (all-cause mortality, bleeding-related mortality, upper gastrointestinal bleeding) as well as haemodynamic outcomes (hepatic venous pressure (HVPG) reduction, haemodynamic response rate, post-treatment arterial blood pressure (mean arterial pressure; MAP) and adverse events).

Results: 12 RCTs were included. In 7 trials that looked at haemodynamic outcomes compared carvedilol versus propranolol, showing that carvedilol was associated with a greater reduction (%) of HVPG within 6 months (mean difference -8.49, 95% CI -12.36 to -4.63) without a greater reduction in MAP than propranolol. In 3 trials investigating differences in clinical outcomes between carvedilol versus endoscopic variceal band ligation (EVL), no significant differences in mortality or variceal bleeding were demonstrated. 1 trial compared clinical outcomes between carvedilol versus nadolol plus isosorbide-5-mononitrate (ISMN), and showed that no significant difference in mortality or bleeding had been found. 1 trial comparing carvedilol versus nebivolol showed a greater reduction in HVPG after 14 days follow-up in the carvedilol group.

Conclusions: Carvedilol may be more effective in decreasing HVPG than propranolol or nebivolol and it may be as effective as EVL or nadolol plus ISMN in preventing variceal bleeding. However, the overall quality of evidence is low. Further large-scale randomised studies are required before we can make firm conclusions.

Trial registration number: CRD42015020542.

Keywords: CLINICAL PHARMACOLOGY; GENERAL MEDICINE (see Internal Medicine).

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Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Risk of bias. Risk of bias graph (A); risk of bias summary (B).
Figure 3
Figure 3
Carvedilol versus propranolol. Percentage of hepatic venous pressure (HVPG) reduction (1.1.1 outcome assessed within 24 h; 1.1.2 outcome assessed 24 h–6 months; A); haemodynamic response rate (1.2.1 outcome assessed within 24 h; 1.2.2 outcome assessed 24 h–6 months; B); post-treatment MAP (1.3.1 outcome assessed within 24 h; 1.3.2 outcome assessed 24 h–6 months; C).
Figure 4
Figure 4
Carvedilol versus endoscopic variceal band ligation for primary prophylaxis. All-cause mortality (A); bleeding-related mortality (B); upper gastrointestinal bleeding (C).
See this image and copyright information in PMC

References

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