P2038 - Safety and Efficacy of Continuous vs Intermittent Terlipressin for Acute Esophageal Variceal Bleeding - A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Award: Presidential Poster Award

Parth Patel, MD¹, Fnu Nivedita, MBBS², Daniel Martin Simadibrata, MD, MS³, Priyadarshini Loganathan, MD⁴, Vishali Moond, MD⁵, Lena Kassab, MD, MBA⁶, Babu Mohan, MD, MS^7
1Ascension Saint Joseph Hospital, Chicago, IL; ²Kasturba Medical College, Manipal, Karnataka, India; ³University of Oxford, UK, Jakarta, Jakarta Raya, Indonesia; ⁴University of Texas Health Science Center, San Antonio, TX; ⁵Saint Peter's University Hospital / Robert Wood Johnson Medical School, New Brunswick, NJ; ⁶Mayo Clinic, Rochester, MN; ⁷University of Utah Health School of Medicine, Salt Lake City, UT

Introduction: Terlipressin is a vasoactive agent used in the management of acute esophageal variceal bleeding (AEVB). Terlipressin wasn’t approved in the US due to safety concerns until recently, where it is now approved for the management of hepatio-renal syndrome. Pharmacokinetics of terlipressin allows for intermittent dosing, however studies have demonstrated that continuous dosing might yield better outcomes. This meta-analysis aims to evaluate safety and efficacy of continuous vs intermittent Terlipressin for AEVB.

Methods: Six databases (Pubmed, Scopus, Embase, Medline, Web of Science, CCRCT) were screened from inception until Feb, 2023. Only RCTs that evaluated efficacy and safety of continuous vs intermittent administration of terlipressin for AEVB were included. Standard meta-analysis methodology was followed using the random-effects model, and heterogeneity was assessed by I2 statistics.

Results: 4 studies met the inclusion criteria, comprising a total of 291 patients (141 continuous & 150 intermittent).The etiology of AEVB were: alcohol(31%), HBV(18%), NASH(16%), HCV(7.4%), & others(23.7%). Mean MELD-Na reported in these studies was 15.9±6.7(continuous group) and 16.6±7.01(intermittent group); Mean Child-Turcotte-Pugh(CTP) score reported in these studies was 8.7±2.05 (continuous group) and 8.9±1.8(intermittent group); mean varices grade 2.4±0.6(continuous group) and 2.5±0.6(intermittent group).

The pooled risk of re-bleeding within 12 weeks of initial episode (RR:0.44[0.27,0.71], I2 0%, p=0.01), adverse events (RR:0.64 [9.42,0.95], I20%, p=0.02), and mean length of hospital stay(day) (RR: 0.52[0.02-1.03], I2 61.1%, p=0.04) were significantly favorable to continuous terlipressin group.

No significant difference in mortality (RR: 0.70, [0.34,1.43],I20%, p=0.3) and RBC transfusion rate (RR:0.21[-0.16,5.9], I2 0%,p=0.2) were noted between the groups.

Discussion: This meta-analysis of four RCTs demonstrates favorable outcomes in terms of safety and clinical efficacy of continuous terlipressin infusion in comparison to intermittent dosing for AEVB, albeit limited by small number of studies. Interestingly the risk of adverse events were favorable with continuous dosing. Future high quality RCTs are needed to further validate these outcomes. Additionally, continuous terlipressin could potentially be expensive as compared to intermittent dosing, therefore a cost-effectiveness analysis would be useful to guide therapy in resource-limited settings.



Disclosures:


Parth Patel, MD¹, Fnu Nivedita, MBBS², Daniel Martin Simadibrata, MD, MS³, Priyadarshini Loganathan, MD⁴, Vishali Moond, MD⁵, Lena Kassab, MD, MBA⁶, Babu Mohan, MD, MS⁷. P2038 - Safety and Efficacy of Continuous vs Intermittent Terlipressin for Acute Esophageal Variceal Bleeding - A Systematic Review and Meta-Analysis of Randomized Controlled Trials, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.