The efficacy and safety of rifaximin-α: a 2-year observational study of overt hepatic encephalopathy

摘要

After 5??years since the registration of rifaximin-α as a secondary prophylaxis for overt hepatic encephalopathy (HE) in the Netherlands, we aimed to evaluate the use of hospital resources and safety of rifaximin-α treatment in a real-world setting. We carried out prospective identification of all patients using rifaximin-α for overt HE. We assessed hospital resource use, bacterial infections, and adverse events during 6-month episodes before and after rifaximin-α initiation. During 26?months we included 127 patients [71.7% male; median age 60.8?years (interquartile range: 56.2-66.1); median model for end-stage liver disease (MELD) score 15.0 (interquartile range: 12.1-20.4); 98% using lactulose treatment]. When comparing the first 6?months after rifaximin-α initiation with the prior 6?months, HE-related hospital admissions decreased (0.86 to 0.41?admissions/patient; p??0.001), as well as the mean length of stay (8.85 to 3.79?bed days/admission; p??0.001). No significant differences were found regarding HE-related intensive care unit admissions (0.09 to 0.06?admission/patient; p?=?0.253), stay on the intensive care unit (0.43 to 0.57?bed days/admission; p?=?0.661), emergency department visits (0.66 to 0.51?visits/patient; p?=?0.220), outpatient clinic visits (2.49 to 3.30?bed visits/patient; p?=?0.240), or bacterial infections (0.41 to 0.35?infections/patient; p?=?0.523). Adverse events were recorded in 2.4% of patients. The addition of rifaximin-α to lactulose treatment was associated with a significant reduction in the number and length of HE-related hospitalizations for overt HE. Rifaximin-α treatment was well tolerated.