Rifaximin versus nonabsorbable disaccharides in the management of hepatic encephalopathy: a meta-analysis.
OBJECTIVE
To compare the positive and negative effects of rifaximin and nonabsorbable disaccharides in patients with hepatic encephalopathy.


METHODS
We used the method recommended by The Cochrane Collaboration to perform a meta-analysis of comparative randomized trials of rifaximin and nonabsorbable disaccharides.


RESULTS
Seven randomized controlled trials were identified, but only five trials involving 264 patients met all the inclusion criteria. There was no significant difference between rifaximin and nonabsorbable disaccharides on improvement in patients with hepatic encephalopathy [relative risk (RR) 1.08; 95% confidence interval (CI), 0.85-1.38; P=0.53]. RR was 0.98 (95% CI: 0.85-1.13; P=0.74) for acute hepatic encephalopathy in 157 patients and 0.87 (95% CI: 0.40-1.88; P=0.72) for chronic hepatic encephalopathy in 96 patients, respectively. There was no significant difference between rifaximin and nonabsorbable disaccharides on diarrhea (RR=0.90; 95% CI: 0.17-4.70; P=0.90). However, a significant difference in favor of rifaximin on abdominal pain (RR=0.28; 95% CI: 0.08-0.95; P=0.04) was identified.


CONCLUSIONS
Rifaximin is not superior to nonabsorbable disaccharides for acute or chronic hepatic encephalopathy in the long-term or short-term treatment except that it may be better tolerated. Further studies on larger populations are required to provide more sufficient evidence for assessment of the use of rifaximin.
Jiang
Qian
Q
Department of Clinical Pharmacy, West China School of hepatic encephalopathy, Sichuan University, Chengdu, China.
Jiang
Xue-Hua
XH
Zheng
Ming-Hua
MH
Jiang
Liu-Ming
LM
Chen
Yong-Ping
YP
Wang
Li
L
D004187:Disaccharides / Q000191:economics / Q000627:therapeutic use*; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012294:Rifamycins / Q000009:adverse effects / Q000627:therapeutic use*; D000078262:Rifaximin; D016896:Treatment Outcome
D004187:Disaccharides; D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin