UK: The use of carvedilol improves overall survival in patients with cirrhosis and portal hypertension, finds a recent study in the journal Alimentary Pharmacology & Therapeutics.
In patients with cirrhosis with portal hypertension, primary prophylaxis of variceal haemorrhage with non‐selective beta blockers (NSBB) or variceal band ligation (VBL) is the standard of care. NSBB, and particularly carvedilol may improve survival. Hannah R. McDowell, Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK, and colleagues aimed to assess mortality in a cohort of patients previously randomised to either carvedilol or VBL.
For the purpose, the researchers retrospectively analysed 152 patients who were recruited to a multi‐centre randomised controlled trial between 7 April 2000 and 24 June 2006. The trial was designed to assess the efficacy of VBL versus carvedilol in preventing first variceal bleed.
The researchers used electronic records to undertake long‐term follow‐up (up to 20 years). The primary outcome of all‐cause mortality and secondary end points of liver‐related mortality and decompensation events (ascites, encephalopathy, variceal bleeding).
152 patients were included in analysis with baseline characteristics well matched between the carvedilol (n = 77) and VBL (n = 75) groups.
Key findings of the study include:
In the intention‐to‐treat analysis, carvedilol offered a significant survival advantage with median survival of 7.8 years compared to 4.2 years in the VBL group.
This survival benefit was maintained in per‐protocol analysis when patients who crossed between treatment arms were excluded.
Transplant‐free survival, liver‐related mortality and decompensation events were similar in both groups.
The study titled, "Carvedilol is associated with improved survival in patients with cirrhosis: a long‐term follow‐up study," is published in the journal Alimentary Pharmacology & Therapeutics.
DOI: https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.16189