Abbreviated Duration of Vasoactive Agents Has Similar Outcomes as Standard Duration of Therapy in Patients with Liver Cirrhosis and Variceal Bleeding: An Individual Patient Data Meta-Analysis.

Abstract

Background: This two-stage individual patient data meta-analysis (IPD-MA) compared the efficacy of a shorter duration (≤ 2 days) of vasoactive (VA) drug therapy to standard duration (3-5 days) after acute variceal bleeding (AVB) in patients with liver cirrhosis.

Patients and methods: Randomized clinical trials on patients with cirrhosis and AVB undergoing endoscopic band ligation which compared a short duration versus the standard duration of VA therapy were included. The primary outcome was 5-day rebleeding rate. Secondary outcomes included 5-day and 42-day mortality, 42-day rebleeding rate, and length of hospital stay in patients receiving short duration of therapy as compared to those receiving standard duration. Aggregate data meta-analysis and IPD-MA of trials were performed for these outcomes and comparisons in patients with different severities of liver disease.

Results: Out of 11 eligible trials, 542 IPD data sets were available from 6 trials. Two hundred and seventy-nine patients received short duration and 263 received standard duration VA therapy. Two-stage IPD-MA revealed no significant differences in the 5-day rebleeding rate (HR = 0.59, 95%CI: 0.19-1.81, p = 0.66), 5-day mortality (HR = 1.12, 95%CI: 0.18-6.63, p = 0.44), 42-day rebleeding rate (HR = 0.95, 95%CI: 0.47-1.90, p = 0.90) and 42-day mortality (HR = 1.05, 95% CI: 0.43-2.56, p = 0.34) between the two groups. One-stage IPD-MA revealed no significant differences in the outcomes across Child-Pugh classes, with shorter hospital stay in short duration group.

Conclusions: Short duration VA therapy has similar outcomes to standard duration in patients with liver cirrhosis presenting with AVB, irrespective of severity of liver disease.