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. 2020 Jan 27;12(1):10-20.
doi: 10.4254/wjh.v12.i1.10.

Lessons from "real life experience" of rifaximin use in the management of recurrent hepatic encephalopathy

Fiona Chautant  1 , Maeva Guillaume  2 , Marie-Angèle Robic  2 , Jean-François Cadranel  3 , Jean-Marie Peron  2 , Hortensia Lison  3 , Charlène Cool  4 , Christophe Bureau  2 , Véronique Duhalde  5
Affiliations

Lessons from "real life experience" of rifaximin use in the management of recurrent hepatic encephalopathy

Fiona Chautant et al. World J Hepatol. .

Abstract

Background: Hepatic encephalopathy (HE) is a major complication of cirrhosis with independent prognostic significance. The current management of HE is mainly based on lactulose. Rifaximin has been shown to decrease the risk of HE recurrence in patients with episodic forms. HE can also be persistent. However, there is no drug support recommendation for rifaximin use in this setting.

Aim: To assess the effectiveness of rifaximin in the management of recurrent episodes of HE and recurrent acute exacerbations on persistent HE, in "real life conditions".

Methods: In this retrospective study, using a within-subjects design, we collected data of patients treated with rifaximin for HE in two liver diseases centers, during the six-month period before and during the six-month period after the initiation of rifaximin. The primary effectiveness endpoint was the total number of HE events involving hospitalization.

Results: Rifaximin was introduced for prevention of recurrent HE episodes in 29 out of 62 patients with normal mental status between episodes and for prevention of recurrent acute exacerbations on persistent HE in 33 out of 62 patients. In the "prevention of recurrent HE episodes" group, fewer HE events (0.79 vs 1.78; P = 0.013) were reported during the period of time when rifaximin was used. In the "prevention of recurrent acute exacerbations on persistent HE" group, there was no significant difference in the number of HE-events (1.48 vs 1.77; P = 0.582).

Conclusion: In this real-life experience, the effectiveness of rifaximin was confirmed in the prevention of HE episodes recurrence but was not proved in the prevention of acute exacerbations recurrence on persistent HE.

Keywords: Cirrhosis; Hepatic encephalopathy; Hospitalization; Liver disease; Rifaximin.

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Conflict of interest statement

Conflict-of-interest statement: Bureau C and Cadranel JF have conflicts of interest with Alpha Wassermann as speakers at a symposium and Norgine as consultants. The remaining authors disclose no conflict.

Figures

Figure 1
Figure 1
Comparison of hepatic encephalopathy events, hepatic encephalopathy-related hospitalizations and length of hepatic encephalopathy-related hospitalization with or without rifaximin for entire cohort and subgroups “prevention of recurrent hepatic encephalopathy” and “prevention of an acute episode on persistent hepatic encephalopathy”. A: Entire cohort; B: Prevention of recurrent hepatic encephalopathy (HE) episodes; C: Prevention of recurrent acute exacerbations on persistent HE. The results are expressed for 100 d of follow-up. HE: Hepatic encephalopathy.
Figure 2
Figure 2
Probability of hepatic encephalopathy recurrence during rifaximin therapy in the subgroup “Prevention of recurrent hepatic encephalopathy”, n = 29; Kaplan-Meier method. 1Censored data correspond to discontinuation of treatment before the occurrence of hepatic encephalopathy (HE). At the end of follow-up, it corresponded to “HE-free” patients, after six months of treatment.
Figure 3
Figure 3
Cessation probability of persistent hepatic encephalopathy during rifaximin therapy in the subgroup “Prevention of an acute episode on persistent hepatic encephalopathy”, n = 33; Kaplan-Meier method. 1Censored data correspond to discontinuation of treatment before cessation of hepatic encephalopathy (HE). At the end of follow-up, it corresponded to patients with maintenance of persistent HE.
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