A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome.
OBJECTIVE
Hepatorenal syndrome (HRS) type 1 is a progressive functional renal failure in subjects with advanced liver disease. The aim of this study was to evaluate the efficacy and safety of terlipressin, a systemic arterial vasoconstrictor, for cirrhosis type 1 HRS.


METHODS
A prospective, randomized, double-blind, placebo-controlled clinical trial of terlipressin was performed. Subjects with type 1 HRS were randomized to terlipressin (1 mg intravenously every 6 hours) or placebo plus albumin in both groups. The dose was doubled on day 4 if the serum creatinine (SCr) level did not decrease by 30% of baseline. Treatment was continued to day 14 unless treatment success, death, dialysis, or transplantation occurred. Treatment success was defined by a decrease in SCr level to </=1.5 mg/dL for at least 48 hours by day 14 without dialysis, death, or relapse of HRS type 1.


RESULTS
Fifty-six subjects were randomized to each arm. Treatment success with terlipressin was double that with placebo (25% vs 12.5%, P = .093). SCr level improved from baseline to day 14 on terlipressin (-0.7 mg/dL) as compared with placebo (0 mg/dL), P < .009. Terlipressin was superior to placebo for HRS reversal (34% vs 13%, P = .008), defined by decrease in SCr level </=1.5 mg/dL. Overall and transplantation-free survival was similar between study groups; HRS reversal significantly improved survival at day 180. One nonfatal myocardial infarction occurred with terlipressin, but the total adverse event rate was similar to placebo.


CONCLUSIONS
Terlipressin is an effective treatment to improve renal function in HRS type 1.
Sanyal
Arun J
AJ
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA. ajsanyal@hsc.vcu.edu
Boyer
Thomas
T
Garcia-Tsao
Guadalupe
G
Regenstein
Frederick
F
Rossaro
Lorenzo
L
Appenrodt
Beate
B
Blei
Andres
A
Gülberg
Veit
V
Sigal
Samuel
S
Teuber
Peter
P
D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006530:Hepatorenal Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D007677:Kidney Function Tests; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012426:Russia / Q000453:epidemiology; D012720:Severity of Illness Index; D012772:Shock, Septic; D015996:Survival Rate; D000077585:Terlipressin; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin