title: Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity.
abstract: OBJECTIVE
  Satavaptan, a vasopressin V2 receptor antagonist, has been shown to improve the control of ascites in cirrhosis in short-term phase II studies. The aim of this study was to evaluate the efficacy and safety of satavaptan in three different populations of patients with cirrhosis and ascites.
  
  
  METHODS
  1200 patients were included in three randomised double-blind studies comparing satavaptan with placebo in uncomplicated ascites (study 1: n=463 patients) and difficult-to-treat ascites, with and without concomitant diuretic treatment (studies 2 and 3: n=497 and n=240 patients, respectively).
  
  
  RESULTS
  Satavaptan was not more effective than placebo in the control of ascites in any of the populations studied as estimated by the primary efficacy endpoints: worsening of ascites (study 1) and the cumulative number of large-volume paracenteses during 12 weeks (studies 2 and 3). Nevertheless, some of the secondary efficacy endpoints related to the treatment of ascites were met in the three studies, suggesting a slight advantage of satavaptan over placebo in delaying ascites formation. Moreover, satavaptan was more effective than placebo in improving the serum sodium concentration in patients with hyponatraemia. The incidence of major complications of cirrhosis during follow-up did not differ significantly between the satavaptan and placebo groups in the three studies. Overall, the rate of any treatment-related adverse events, serious treatment-related events and treatment-related events leading to permanent discontinuation of treatment did not differ significantly between the treatment groups. However, in study 2 mortality was higher in patients treated with satavaptan compared with placebo (HR 1.47; 95% CI 1.01 to 2.15); no significant differences in mortality between the two groups were observed in the other two studies. No specific cause for the increased mortality was identified. Most deaths were associated with known complications of liver cirrhosis.
  
  
  CONCLUSIONS
  Satavaptan, alone or in combination with diuretics, is not clinically beneficial in the long-term management of ascites in cirrhosis.
authors.affiliation: Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.forename: Hugh
authors.initials: H
authors.lastname: Watson
authors.forename: Alexander
authors.initials: A
authors.lastname: Gerbes
authors.forename: Hendrik
authors.initials: H
authors.lastname: Vilstrup
authors.forename: Salvatore
authors.initials: S
authors.lastname: Badalamenti
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D013141:Spiro Compounds / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D004232:Diuretics; D009025:Morpholines; D013141:Spiro Compounds; C103281:satavaptan