Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome

A randomized trial

Marta Cavallin, Patrick S. Kamath, Manuela Merli, Silvano Fasolato, Pierluigi Toniutto, Francesco Salerno, Mauro Bernardi, Roberto Giulio Romanelli, Cosimo Colletta, Freddy Salinas, Antonio Di Giacomo, Lorenzo Ridola, Ezio Fornasiere, Paolo Caraceni, Filippo Morando, Salvatore Piano, Angelo Gatta, Paolo Angeli

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4%) compared to the MID/OCT group (6/21, 28.6%), P=0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival. Conclusion: Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalHepatology
Volume62
Issue number2
DOIs
Publication statusPublished - Aug 1 2015

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Midodrine
Hepatorenal Syndrome
Octreotide
Albumins
Therapeutics
Kidney
terlipressin
End Stage Liver Disease
Recovery of Function
Intravenous Infusions
Fibrosis
Randomized Controlled Trials
Body Weight

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)

Cite this

Cavallin, M., Kamath, P. S., Merli, M., Fasolato, S., Toniutto, P., Salerno, F., ... Angeli, P. (2015). Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial. Hepatology, 62(2), 567-574. https://doi.org/10.1002/hep.27709

Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome : A randomized trial. / Cavallin, Marta; Kamath, Patrick S.; Merli, Manuela; Fasolato, Silvano; Toniutto, Pierluigi; Salerno, Francesco; Bernardi, Mauro; Romanelli, Roberto Giulio; Colletta, Cosimo; Salinas, Freddy; Di Giacomo, Antonio; Ridola, Lorenzo; Fornasiere, Ezio; Caraceni, Paolo; Morando, Filippo; Piano, Salvatore; Gatta, Angelo; Angeli, Paolo.

In: Hepatology, Vol. 62, No. 2, 01.08.2015, p. 567-574.

Research output: Contribution to journalArticle

Cavallin, M, Kamath, PS, Merli, M, Fasolato, S, Toniutto, P, Salerno, F, Bernardi, M, Romanelli, RG, Colletta, C, Salinas, F, Di Giacomo, A, Ridola, L, Fornasiere, E, Caraceni, P, Morando, F, Piano, S, Gatta, A & Angeli, P 2015, 'Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: A randomized trial', Hepatology, vol. 62, no. 2, pp. 567-574. https://doi.org/10.1002/hep.27709
Cavallin, Marta ; Kamath, Patrick S. ; Merli, Manuela ; Fasolato, Silvano ; Toniutto, Pierluigi ; Salerno, Francesco ; Bernardi, Mauro ; Romanelli, Roberto Giulio ; Colletta, Cosimo ; Salinas, Freddy ; Di Giacomo, Antonio ; Ridola, Lorenzo ; Fornasiere, Ezio ; Caraceni, Paolo ; Morando, Filippo ; Piano, Salvatore ; Gatta, Angelo ; Angeli, Paolo. / Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome : A randomized trial. In: Hepatology. 2015 ; Vol. 62, No. 2. pp. 567-574.
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abstract = "Hepatorenal syndrome (HRS), a serious complication of cirrhosis, is associated with high mortality without treatment. Terlipressin with albumin is effective in the reversal of HRS. Where terlipressin is not available, as in the United States, midodrine and octreotide with albumin are used as an alternative treatment of HRS. The aim was to compare the effectiveness of terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of HRS in a randomized controlled trial. Twenty-seven patients were randomized to receive terlipressin with albumin (TERLI group) and 22 to receive midodrine and octreotide plus albumin (MID/OCT group). The TERLI group received terlipressin by intravenous infusion, initially 3 mg/24 hours, progressively increased to 12 mg/24 hours if there was no response. The MID/OCT group received midodrine orally at an initial dose of 7.5 mg thrice daily, with the dose increased to a maximum of 12.5 mg thrice daily, together with octreotide subcutaneously: initial dose 100 μg thrice daily and up to 200 μg thrice daily. Both groups received albumin intravenously 1 g/kg of body weight on day 1 and 20-40 g/day thereafter. There was a significantly higher rate of recovery of renal function in the TERLI group (19/27, 70.4{\%}) compared to the MID/OCT group (6/21, 28.6{\%}), P=0.01. Improvement in renal function and lower baseline Model for End-Stage Liver Disease score were associated with better survival. Conclusion: Terlipressin plus albumin is significantly more effective than midodrine and octreotide plus albumin in improving renal function in patients with HRS.",
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AU - Kamath, Patrick S.

AU - Merli, Manuela

AU - Fasolato, Silvano

AU - Toniutto, Pierluigi

AU - Salerno, Francesco

AU - Bernardi, Mauro

AU - Romanelli, Roberto Giulio

AU - Colletta, Cosimo

AU - Salinas, Freddy

AU - Di Giacomo, Antonio

AU - Ridola, Lorenzo

AU - Fornasiere, Ezio

AU - Caraceni, Paolo

AU - Morando, Filippo

AU - Piano, Salvatore

AU - Gatta, Angelo

AU - Angeli, Paolo

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