title: Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage.
abstract: Vasoactive drugs are recommended to be started as soon as possible in suspected variceal bleeding, even before diagnostic endoscopy. However, it is still unclear whether the therapeutic efficacies of the various vasoactive drugs used are comparable. The aim of this prospective, multicenter, randomized, noninferiority trial was to characterize the effects of terlipressin, somatostatin, and octreotide when they are initiated before endoscopic treatment in patients with acute variceal bleeding. Patients with liver cirrhosis and significant upper gastrointestinal bleeding were randomly assigned to receive early administration of terlipressin, somatostatin, or octreotide, followed by endoscopic treatment. Patients with nonvariceal bleeding were excluded after endoscopy. The primary endpoint was 5-day treatment success, defined as control of bleeding without rescue treatment, rebleeding, or mortality, with a noninferiority margin of 0.1. In total, 780 patients with variceal bleeding were enrolled: 261 in the terlipressin group; 259 in the somatostatin group; and 260 in the octreotide group. At the time of initial endoscopy, active bleeding was noted in 43.7%, 44.4%, and 43.5% of these patients, respectively (P=0.748), and treatment success was achieved by day 5 in 86.2%, 83.4%, and 83.8% (P=0.636), with similar rates of control of bleeding without rescue treatment (89.7%, 87.6%, and 88.1%; P=0.752), rebleeding (3.4%, 4.8%, and 4.4%; P=0.739), or mortality (8.0%, 8.9%, and 8.8%; P=0.929). The absolute values of the lower bound of confidence intervals for terlipressin versus somatostatin, terlilpressin versus octreotide, and octreotide versus somatostatin were 0.095, 0.090, and 0.065, respectively.
  
  
  CONCLUSIONS
  Hemostatic effects and safety did not differ significantly between terlipressin, somatostatin, and octreotide as adjuvants to endoscopic treatment in patients with acute gastroesophageal variceal bleeding.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Park
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Byoung Kuk
authors.initials: BK
authors.lastname: Jang
authors.forename: Hong Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Taeho
authors.initials: T
authors.lastname: Hahn
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Jeong
authors.initials: J
authors.lastname: Heo
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Won Young
authors.initials: WY
authors.lastname: Tak
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Jae Seok
authors.initials: JS
authors.lastname: Hwang
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
mesh_terms: D000208:Acute Disease; D000328:Adult; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D011446:Prospective Studies; D013004:Somatostatin / Q000627:therapeutic use*; D000077585:Terlipressin; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D013004:Somatostatin; D000077585:Terlipressin; D015282:Octreotide