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Meta-Analysis
. 2022 Apr 26;17(4):e0267647.
doi: 10.1371/journal.pone.0267647. eCollection 2022.

Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis

Jian Fu  1 , Yi Gao  1 , Li Shi  1
Affiliations
Meta-Analysis

Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis

Jian Fu et al. PLoS One. .

Abstract

Rifaximin and lactulose are widely used in patients with hepatic encephalopathy (HE); however, data on whether the combined use of rifaximin and lactulose could yield additional benefits for patients with HE are limited and inconclusive. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the treatment effectiveness of rifaximin plus lactulose versus lactulose alone in patients with HE. Electronic databases (PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure) were searched for eligible RCTs from their inception until November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were applied to calculate pooled effect estimates for the treatment effectiveness of rifaximin plus lactulose versus lactulose alone by using the random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed. We included 7 RCTs enrolling 843 patients with HE. We noted that the use of rifaximin plus lactulose was associated with an increased incidence of effective rate than lactulose alone (RR, 1.30; 95% CI, 1.10-1.53; P = 0.002). Moreover, the use of rifaximin plus lactulose was associated with a reduced risk of mortality as compared with lactulose alone (RR, 0.57; 95% CI, 0.41-0.80; P = 0.001). This study found that the use of rifaximin in combination with lactulose could provide additional benefits in terms of increased effective rate and decreased mortality than lactulose alone in patients with HE.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The PRISMA flowchart for the literature search and study selection.
Fig 2
Fig 2. Effect of rifaximin plus lactulose versus lactulose alone on the incidence of effective rate.
Fig 3
Fig 3. Effect of rifaximin plus lactulose versus lactulose alone on the risk of mortality.
Fig 4
Fig 4. Sensitivity analyses for effective rate and mortality.
Fig 5
Fig 5. Funnel plot for effective rate and mortality.
(A) Effective rate. (B) Mortality.
See this image and copyright information in PMC

References

    1. Tapper EB, Zhao L, Nikirk S, Baki J, Parikh ND, Lok AS, et al.. Incidence and Bedside Predictors of the First Episode of Overt Hepatic Encephalopathy in Patients With Cirrhosis. Am J Gastroenterol. 2020;115: 2017–2025. doi: 10.14309/ajg.0000000000000762 - DOI - PMC - PubMed
    1. Fichet J, Mercier E, Genée O, Garot D, Legras A, Dequin PF, et al.. Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy. J Crit Care. 2009;24: 364–370. doi: 10.1016/j.jcrc.2009.01.008 - DOI - PubMed
    1. Luo M, Ma P, Li L, Cao WK. Advances in psychometric tests for screening minimal hepatic encephalopathy: From paper-and-pencil to computer-aided assessment. Turk J Gastroenterol. 2019;30: 398–407. doi: 10.5152/tjg.2019.18226 - DOI - PMC - PubMed
    1. Jepsen P, Ott P, Andersen PK, Sorensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis: a Danish population-based cohort study. Hepatology. 2010;51: 1675–1682. doi: 10.1002/hep.23500 - DOI - PubMed
    1. Bajaj JS, Wade JB, Gibson DP, Heuman DM, Thacker LR, Sterling RK, et al.. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol. 2011;106: 1646–1653. doi: 10.1038/ajg.2011.157 - DOI - PMC - PubMed

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