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Published on: June 18, 2020
Carvedilol versus Propranolol in Preventing Decompensation in Patients with Compensated Cirrhosis: A Real-World
Hussam Almasri1, Muhammad Ali Butt2, Rahul Karna3
1University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA. hussamalmasri10@gmail.com.
Insights
Carvedilol is more effective than propranolol in preventing decompensating events in liver cirrhosis patients. This real-world study shows carvedilol reduces ascites, variceal bleeding, and hepatic encephalopathy, but mortality benefits need further investigation.
Area of Science:
- Hepatology
- Pharmacology
- Clinical Medicine
Background:
- Non-selective beta-blockers are standard for portal hypertension and variceal bleeding prevention in cirrhosis.
- Carvedilol shows better portal pressure reduction than propranolol, but real-world decompensation data are limited.
Purpose of the Study:
- To compare the real-world efficacy of carvedilol versus propranolol in preventing decompensation in compensated cirrhosis patients.
- To evaluate decompensatory events, hospitalization, and mortality in patients treated with either carvedilol or propranolol.
Main Methods:
- Retrospective cohort study using the TriNetX database.
- Adult patients with compensated cirrhosis prescribed carvedilol or propranolol were included.
- Propensity score matching balanced patient characteristics; decompensation, hospitalization, and mortality were outcomes.
Main Results:
- After matching 12,890 patients per group, carvedilol significantly reduced decompensatory events (ascites, variceal bleeding, hepatic encephalopathy, hepatorenal syndrome) within five years.
- No significant difference in spontaneous bacterial peritonitis was observed.
- Carvedilol showed a trend towards reduced all-cause mortality at five years.
Conclusions:
- Carvedilol demonstrates superior efficacy over propranolol in preventing key decompensatory events in compensated cirrhosis patients.
- Carvedilol's benefit is likely linked to its superior portal pressure-lowering effects.
- A definitive mortality benefit for carvedilol requires further research.
Background And Aims:
Non-selective beta-blockers are widely used for the management of portal hypertension and prevention of variceal bleeding in patients with liver cirrhosis. While studies have demonstrated carvedilol's superiority in reducing portal pressure compared to propranolol, limited real-world data directly compare their efficacy in preventing decompensation.
Methods:
We conducted a retrospective cohort study using the TriNetX database on patients from several healthcare organizations in the US Collaborative Network. Cohorts were defined as adult patients with compensated cirrhosis who were prescribed either carvedilol or propranolol. Propensity score matching was applied to balance demographic, clinical, and laboratory characteristics. The first decompensation event, all-cause hospitalization, and all-cause mortality were defined as outcomes.
Results:
After matching, each cohort included 12,890 patients. The mean age was 59.6 years. Comorbidities and laboratory findings were well-balanced between the two groups. Patients receiving carvedilol had a significantly lower risk of developing new decompensating events within five years, including ascites, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. Spontaneous bacterial peritonitis was not significantly different between the groups. Post-matching analysis showed marginally reduced all-cause mortality in the carvedilol group at five years.
Conclusions:
In this real-world study, carvedilol demonstrated superior efficacy compared with propranolol in reducing key decompensatory events in patients with compensated cirrhosis, likely due to its enhanced ability to lower portal pressure. However, the mortality benefit probably requires further studies to unfold.
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