HDCN Abstract:  ASN Annual Meeting 2020 -- Digital Meeting  

Velez JCQ, Befeler A, Kurtz I, et al.

Terlipressin Improves Renal Replacement Therapy–Free Survival in Hepatorenal Syndrome Type 1

ASN Annual Meeting 2020 -- Digital Meeting
J Am Soc Nephrol (Oct) 31:15A 2020

BACKGROUND

Hepatorenal syndrome type 1 (HRS-1) is an ominous form of acute kidney injury in patients with cirrhosis. Recently, the results of the randomized placebo (PBO)-controlled trial (RCT) CONFIRM demonstrated that terlipressin (TERLI) is effective in reversing HRS-1 and in reducing the cumulative need for renal replacement therapy (RRT). However, whether TERLI reduces the need for RRT among survivors has not been determined.

METHODS

CONFIRM (NCT02770716) was a North American RCT (n=300) that compared HRS-1 reversal rates between patients treated with albumin plus TERLI (n=199) or albumin plus PBO (n=101) (2:1). We conducted a post hoc intention-to-treat analysis to assess the incidence of RRT among CONFIRM survivors. We also conducted a pooled analysis of the 3 TERLI RCTs in HRS-1 (OT-0401 [NCT00089570], REVERSE [NCT01143246], and CONFIRM) to examine 90-day RRT-free survival rates.

RESULTS

In CONFIRM, the cumulative incidences of need for RRT for TERLI at day 14, 30, and 90 were 23%, 26%, and 29% compared with 35%, 36%, and 39% for patients assigned to PBO (P=0.03, 0.07, and 0.1, respectively). Among survivors, significantly fewer TERLI-treated patients remained dependent on RRT at day 14, 30, and 90 (22%, 26%, and 30%, respectively) compared with PBO (39%, 43%, and 46%; P<0.01, P=0.03, and P=0.05, respectively). The 90-day RRT-free survival rate was 35% in the TERLI group vs 30% in the PBO group (P=0.08), with a numerically longer median number of days in the TERLI group (20 vs 11). Pooled analysis of the 3 RCTs revealed a greater 90-day RRT-free survival rate for TERLI-treated (n=352) compared with PBO-treated (n=256) patients (37% vs 29%, P=0.03; OR [95% CI], 1.47 [1.04, 2.07]).

CONCLUSION

Treatment with TERLI added to albumin decreased the rate of RRT and improved RRT-free survival in patients with HRS -1. This is the first pharmacological intervention proven to reduce the need for RRT in patients with HRS-1. Because of the significant impact of RRT on quality of life, this observation expands the clinical benefit of TERLI and enhances the reported efficacy of TERLI in inducing HRS-1 reversal.

c Copyright 2020 -2021 American Society of Nephrology. Reproduced with permission.
All ASN abstracts from the 2020 Annual Meeting are available at this link and also are archived in .pdf form at ASN-Online.org

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.