Systematic review: Terlipressin in acute oesophageal variceal haemorrhage

Ioannou, GN, Doust, J and Rockey, DC (2003) Systematic review: Terlipressin in acute oesophageal variceal haemorrhage. Alimentary Pharmacology & Therapeutics, 17 1: 53-64. doi:10.1046/j.1365-2036.2003.01356.x


Author Ioannou, GN
Doust, J
Rockey, DC
Title Systematic review: Terlipressin in acute oesophageal variceal haemorrhage
Journal name Alimentary Pharmacology & Therapeutics   Check publisher's open access policy
ISSN 0269-2813
Publication date 2003
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1046/j.1365-2036.2003.01356.x
Volume 17
Issue 1
Start page 53
End page 64
Total pages 12
Place of publication Oxford
Publisher Blackwell Publishing Ltd
Language eng
Abstract Background: Controversy exists surrounding pharmacological therapy in acute variceal bleeding. Methods: To determine the efficacy and safety of terlipressin. Methods: Randomized trials were identified and duplicate, independent, review identified 20 randomized trials involving 1609 patients that compared terlipressin with placebo, balloon tamponade, endoscopic treatment, octreotide, somatostatin or vasopressin for treatment of acute oesophageal variceal haemorrhage. Results: Meta-analysis showed that compared to placebo, terlipressin reduced mortality (relative risk 0.66, 95% CI 0.49-0.88), failure of haemostasis (relative risk 0.63, 95% CI 0.45-0.89) and the number of emergency procedures per patient required for uncontrolled bleeding or rebleeding (relative risk 0.72, 95% CI 0.55-0.93). When used as an adjuvant to endoscopic sclerotherapy, terlipressin reduced failure of haemostasis (relative risk 0.75, 95% CI 0.58-0.96), and had an effect on reducing mortality that approached statistical significance (relative risk 0.74, 95% CI 0.53-1.04). No significant difference was demonstrated between terlipressin and endoscopic sclerotherapy, balloon tamponade, somatostatin or vasopressin. Haemostasis was achieved more frequently with octreotide compared to terlipressin (relative risk 1.62, 95% CI 1.05-2.50), but this result was based on unblinded studies. Adverse events were similar between terlipressin and the other comparison groups except for vasopressin, which caused more withdrawals due to adverse events. Conclusions: Terlipressin is a safe and effective treatment for acute oesophageal variceal bleeding, with or without adjuvant endoscopic sclerotherapy. Terlipressin appears to reduce mortality in acute oesophageal variceal bleeding compared to placebo, and is the only pharmacological agent shown to do so. Future studies will be required to detect potential mortality differences between terlipressin and other therapeutic approaches.
Keyword Gastroenterology & Hepatology
Pharmacology & Pharmacy
Randomized Controlled Trial
Bleeding Esophageal-varices
Plus Transdermal Nitroglycerin
Placebo-controlled Trial
Double-blind
Portal-hypertension
Cirrhotic-patients
Pharmacological Treatment
Lysine Vasopressin
Liver-cirrhosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 60 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 106 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Mon, 13 Aug 2007, 13:19:50 EST