P0927 - Efficacy and Safety of Variable Treatment Options in the Prevention of Hepatic Encephalopathy: A Systematic Review and Network Meta-Analysis

Mohamed Hammad, MD¹, Abdelwahap Elghezewi, MD¹, Ahmed Abdulhadi H. Younes, MBBCh², Abdelwahhab Alabid, MBBCh³, Abdulfatah Alabid, MBBCh⁴, Yasra Badi, MD⁵, Mohamed Hasham. Gamal, BA⁶, Ibrahim Kamal, MBBCh⁷, Khaled Mohamed Ragab, MBBCh⁸, Ahmed Hashem. Fathallah, MBBCh⁸, Mujtaba Mohamed, MBBS⁹, Ahmed Sherif, MD¹, Wesam Frandah, MD¹⁰, Anas Shaab, MBBCh^11
1Marshall University, Huntington, WV; ²The Princess Alexandra Hospital NHS Trust, Harlow, England, United Kingdom; ³University of Tripoli, New York, NY; ⁴University of Tripoli, Brooklyn, NY; ⁵HCA MountainView Hospital, Arlington, VA; ⁶Tanta University, Benha, Al Qalyubiyah, Egypt; ⁷Al-Azhar University, Alexandria, Al Iskandariyah, Egypt; ⁸Minia University, Minya, Al Minya, Egypt; ⁹Joan C. Edwards School of Medicine, Huntington, WV; ¹⁰Marshall University Joan C. Edwards School of Medicine, Huntington, WV; ¹¹University of Tripoli, Denver, CO

Introduction: As there are no guidelines for the most effective medication to reduce hepatic encephalopathy (HE) or the associated mortality, the purpose of this study is to determine the most effective possible treatment among the single treatment options or the combined treatment options for decreasing the morbidity and mortality of HE. We evaluated the improvement by various outcomes such as the quality of life, reduction in ammonia, all causes of mortality, adverse events, reversal of minimal HE, and development of overt HE.

Methods: We systematically searched PubMed, Cochrane, Web of Science, and Scopus till the 19th of January 2023 for studies that assess the medication options for improvement in patients with hepatic encephalopathy. Data were extracted from eligible studies and pooled in a frequentist network meta-analysis as standardized mean difference (SMD) and their 95% confidence interval (CI) using the MetaInsight web-based tool. Cochrane Tool was used to assessing the quality of the included RCTs, while the NIH tool was used to assess the quality of the included cohort studies. Utilizing the R software, the network meta-analysis was conducted.

Results: In addition to a significant variation in cases of (Lactulose and Rifaxamin) compared with Rifaxamin (RR= 0.39, 95% CI [0.17;0.89]), the results demonstrated a significantly lower incidence of overt HE in (Lactulose and Rifaxamin) compared with placebo (RR= 0.19, 95% CI [0.09; 0.40]). Most arms demonstrated a statistically significant reduction in the incidence of overt HE compared to albumin and placebo. The results also demonstrated a significant reduction in ammonia between LOLA and probiotics (MD= -19.17, 95% CI [-38.01; -0.32]), as well as a significant difference in the incidence of LOLA compared to placebo (MD= -22.62, 95% CI [-39.16;-6.07]).

Discussion: This NMA has significant data for managing subclinical HE in people without a history of overt HE. Our analysis showed that (Lactulose and Rifaxamin), followed by (Rifaxamin and L-carnitine), followed by (Lactulose and Rifaxamin with zinc) were the best combinations regarding overt HE. LOLA reduced ammonia best, followed by Nitazoxanide and finally Lactulose. (Lactulose and Nitazoxanide) have the least adverse effects, followed by (Rifaxamin and L-carnitine), then Probiotics. Yet, all mortality outcomes and quality of life changes yielded no useful findings. Future studies like RCTs must be done to compare our therapies directly.



Disclosures:


Mohamed Hammad, MD¹, Abdelwahap Elghezewi, MD¹, Ahmed Abdulhadi H. Younes, MBBCh², Abdelwahhab Alabid, MBBCh³, Abdulfatah Alabid, MBBCh⁴, Yasra Badi, MD⁵, Mohamed Hasham. Gamal, BA⁶, Ibrahim Kamal, MBBCh⁷, Khaled Mohamed Ragab, MBBCh⁸, Ahmed Hashem. Fathallah, MBBCh⁸, Mujtaba Mohamed, MBBS⁹, Ahmed Sherif, MD¹, Wesam Frandah, MD¹⁰, Anas Shaab, MBBCh¹¹. P0927 - Efficacy and Safety of Variable Treatment Options in the Prevention of Hepatic Encephalopathy: A Systematic Review and Network Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.