title: Efficacy of vasopressin V2 receptor antagonist tolvaptan in treatment of hepatic edema.
abstract: OBJECTIVE
  Tolvaptan, an oral active vasopressin V2 receptor antagonist, is widely used for hepatic edema in Japan, but its clinical benefits have yet to be fully clarified. The present study evaluated the efficacy of tolvaptan in hepatic edema.
  
  
  METHODS
  The efficacy and treatment regimen of tolvaptan were evaluated in 150 patients with hepatic edema by analyzing the initial (day 14) and long-term (day 90) responses to the drug and their predictive factors. All patients were divided into good (Child-Pugh classification B, and absent of advanced hepatocellular carcinoma) and poor hepatic condition groups, and the response rates were compared between the two groups.
  
  
  RESULTS
  The initial response rate was 62%, and the long-term response rate was 47%. The assessment of predictive factors for response to tolvaptan showed that serum creatinine and C-reactive protein levels were important predictors of initial response, and that hepatic conditions, such as the Child-Pugh score or presence of hepatocellular carcinoma, as well as initial response, were significant predictors of long-term response. In addition, both the initial and long-term response rates and the cumulative survival rate were found to be higher in the good hepatic condition group than in the poor hepatic condition group, respectively (71% vs. 57%, P = 0.113; 62% vs. 39%, P = 0.009; log-rank test, P < 0.001).
  
  
  CONCLUSIONS
  These results suggest that tolvaptan may provide high response rates when used early in the course of hepatic edema, or when both hepatic and renal functions are still retained, leading to an improved disease prognosis.
authors.affiliation: Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Hiramine
authors.affiliation: Center for Digestive and Liver Diseases, Miyazaki Medical Center Hospital, Miyazaki, Japan.|Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uto
authors.affiliation: Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hiwaki
authors.affiliation: Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kure
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Ijuin
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Oda
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Mawatari
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Tokunaga
authors.affiliation: Department of Hygiene and Public Health, School of Medicine, National Institute of Fitness and Sports in Kanoya, Kagoshima, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Higashi
authors.affiliation: Department of Radiology, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kanetsuki
authors.affiliation: Department of Internal Medicine, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kubozono
authors.affiliation: Department of Surgery, Kagoshima Kouseiren Hospital, Kagoshima, Japan.
authors.forename: Shigeho
authors.initials: S
authors.lastname: Maenohara
authors.affiliation: Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Ido
keywords: adverse event; hepatic edema; response rate; tolvaptan