Terlipressin is superior to midodrine/octreotide for hepatorenal syndrome type 1
We evaluated 45 patients with HRS-1, defined by occasionally recommended criteria 1, who received terlipressin plus albumin (TERLI group; n=28) or midodrine/octreotide plus albumin (MID/OCT group; n=17) between 2003 and 2014. No patient had alcoholic hepatitis, neoplasia, or contraindications to treatment administered. Terlipressin was administered as an intravenous bolus of 0.5–1 mg per 4 h and 2 mg per 4 h every 3 days if a significant reduction in serum creatinine (≥1 mg/dl) was not observed during each 3-day period. Midodrine and octreotide were administered at a dose of 7.5–12.5 mg orally thrice daily and 100–200 μcg subcutaneously thrice daily, respectively. Ιn our center, intravenous albumin (60–80 g/day for 2 days) was always used in the diagnosis of HRS-1 since 2002 3. Both treatments were given until serum creatinine decreased to less than or equal to 1.5 mg/dl or for a maximum of 14 days. Complete, partial, and no response were defined as a serum creatinine decrease: to 1.5 mg/dl, of 50% or more from baseline to a final value of more than 1.5 mg/dl, and of less than 50% from baseline, respectively. For survival analysis, censoring was performed for death related to progressive/recurrent HRS-1, initiation of dialysis, and liver transplantation.
Causes of HRS-1, baseline serum creatinine, and Child–Pugh/Model for End-Stage Liver Disease scores were similar in both the groups. A significantly greater number of patients in the TERLI group experienced combined partial/complete and complete improvement of renal function than in patients in the MID/OCT group (60.7 vs. 23.5%; P=0.004 and 39.2 vs. 0%; P=0.002, respectively). Responders (partial and full) showed a significantly higher 3-month survival than nonresponders in both the groups (Fig. 1a and b). However, cumulative survival was significantly higher in the TERLI group compared with MID/OCT group (Fig. 1c). No patient discontinued either treatment because of adverse effects.
In line with recent observations, our findings indicate that terlipressin is far more effective than midodrine/octreotide in improving renal function in patients with HRS-1 thus offering a survival benefit.