Which Vasoactive Medications Are Most Effective for Hepatorenal Syndrome?

Terlipressin — recently FDA-approved for this indication — improves HRS reversal and mortality while norepinephrine improves HRS reversal alone.

Patients with cirrhosis who develop hepatorenal syndrome (HRS) have had few therapeutic options beyond intravenous albumin, and many U.S. clinicians have turned to the vasopressor combination midodrine plus octreotide, despite limited supporting evidence. Although terlipressin and norepinephrine have shown some promise for HRS reversal (N Engl J Med 2021; 384:818), trials directly comparing various agents have been small with unclear results. In a network meta-analysis of 26 randomized trials that involved 1736 patients with type 1 hepatorenal syndrome, researchers evaluated terlipressin, norepinephrine, and midodrine plus octreotide.

Findings (compared with placebo) were as follows:

Terlipressin was associated with significantly higher HRS r…

Reviewing Authors

Hila Calev, MD

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Daniel D. Dressler, MD, MSc, MHM, FACP

Disclosures

RoyaltiesMcGraw-Hill; Elsevier

Editorial BoardsMedical Clinics of North America; Caribbean Medical Journal International Advisory Panel (2021–2026)

Which Vasoactive Medications Are Most Effective for Hepatorenal Syndrome?

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Reviewing Authors