Terlipressin remains indispensable in two indications

Česká verze

Authors: H. Gottfriedová
Authors place of work: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
Published in the journal: Gastroent Hepatol 2018; 72(2): 129-133
Category: Hepatologie: přehledová práce
doi: https://doi.org/10.14735/amgh2018129

Summary

Terlipressin was first synthesized more than 54 years ago in former Czechoslovakia. This drug has potent vasoconstrictive and antibleeding effects, which reduce portal pressure and flow in portosystemic shunts, and can be administered in individual doses rather than continuously. Terlipressin is used in clinical practice primarily to treat acute variceal bleeding and hepatorenal syndrome. Other indications include bleeding due to portal gastropathy and bleeding from the gastrointestinal and urogenital tracts in children and in adults, and this drug is also locally applied during gynecological operations on the uterine cervix. Acute variceal bleeding is currently treated according to clearly established procedures and should be initiated upon first contact with the patient. Use of terlipressin in this indication reduces mortality and the risk of bleeding recurrence. Terlipressin is the preferred drug for treatment of hepatorenal syndrome and reduces mortality and improves kidney function in patients with hepatorenal syndrome type 1 and 2. There is no recommended dosage schedule of terlipressin in hepatorenal syndrome patients and the treatment duration is not clearly established. Recurrence of hepatorenal syndrome after discontinuation of terlipressin is usually resolved by re-administration of the drug. The main side effects of terlipressin are myocardial, splanchnic, and acral ischemia.

Key words:
terlipressin – portal hypertension – variceal bleeding – hepatorenal syndrome

The author declares she has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
21. 1. 2018

Accepted:
5. 3. 2018

Zdroje

1. Kasafírek E, Rábek V, Rudinger J et al. Amino acids and peptides. Synthesis of ten extended-chain analogues of lysin vasopressin. Collection Czechoslov Chem Commun 1966; 31: 4581–4591.

2. Vosmík J, Jedlička K, Mulder JL et al. Action of the triglycyl hormonogen of vasopressin (glypressin) in patients with liver cirrhosis and bleeding esophageal varices. Gastroenterology 1977; 72 (4 Pt 1): 605–609.

3. Wells M, Chande N, Adams P et al. Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Aliment Pharmacol Ther 2012; 35 (11): 1267–1278. doi: 10.1111/j.1365-2036.2012.05088.x.

4. De Franchis R, Baveno VI Faculty. Expanding consensus in portal hypertension: Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol 2015; 63 (3): 743–752. doi: 10.1016/j.jhep.2015.05.022.

5. Seo YS, Park SY, Kim M et al. Lack of difference among terlipressin, somatostatin, and octreotide in the control of acute gastroesophageal variceal hemorrhage. Hepatology 2014; 60 (3): 954–963. doi: 10.1002/hep27006.

6. Ioannou G, Doust J, Rockey DC et al. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst Rev 2003; 1: CD002147.

7. De Franchis R et al. Portal hypertension IV: proceedings of the Fourth Baveno International Consensus Workshop. London: Blackwell Publishing 2006.

8. Brůha R, Mareček Z, Špičák J et al. Double-blind randomized, comparative multicenter study of the effect of terlipressin in the treatment of acute esophageal variceal and/or hypertensive gastropathy bleeding. Hepatogastroenterology 2002; 49 (46): 1161–1166.

9. Brůha R, Mareček Z, Procházka V et al. Double-blind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices. Hepatogastroenterology 2009; 56 (90): 390–394.

10. Garcia-Tsao G, Abraldes JG, Berzigotti A et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis and management: 2016 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 65 (1): 310–335. doi: 10.1002/hep.28906.

11. Skládaný L, Jarčuška P, Hrušovský Š et al. Lie?ba a prevencčba a prevencia krvácania pri portalnej hypertenzii. Metodický list racionálnej farmakoterapie. Štandardný diagnostický a terapeutický postup 45 2008; 12 (1–2): 1–8.

12. Fejfar T, Vaňásek T, Brůha R et al. Léčba krvácení v důsledku portální hypertenze při jaterní cirhóze – aktualizace doporučených postupů ČHS ČLS JEP. Gastroent Hepatol 2017; 71 (2): 105–116. doi: 10.14375/amgh2017 105.

13. Ginès P, Guevara M, Arroyo V et al. Hepatorenal syndrome. Lancet 2003; 362 (9398): 1819–1827.

14. Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med 2009; 361 (13): 1279–1290. doi: 10.1056/NEJMra0809139.

15. Wadei HM, Mai ML, Ahsan N et al. Hepatorenal syndrome: pathophysiology and management. Clin J Am Soc Nephrol 2006; 1 (5): 1066–1079.

16. Ginès A, Escorsell A, Ginès P et al. Incidence, predictive factors and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993; 105 (1): 229–236.

17. Arroyo V, Ginès P, Gerbes AL et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996; 23 (1): 164–176.

18. Salerno F, Gerbes A, Ginès P et al. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut 2007; 56 (9): 1310–1318.

19. Duvoux C, Zanditenas D, Hézode C et al. Effects of noradrenalin and albumin in patients with type I hepatorenal syndrome: a pilot study. Hepatology 2002; 36 (2): 374–380. doi: 10.1053/jhep.2002.34343.

20. Singh V, Ghosh S, Singh B et al. Noradrenaline vs. terlipressin in the treatment of hepatorenal syndrome: a randomized study. J Hepatol 2012; 56 (6): 1293–1298. doi: 10.1016/j.jhep.2012.01.012.

21. Israelsen M, Krag A, Allegretti AS et al. Terlipressin versus other vasoactive drugs for hepatorenal syndrome. Cochrane Database Syst Rev 2017; 9: CD011532. doi: 10.1002/14651858.CD011532.pub2.

22. Sanyal AJ, Boyer T, Garcia-Tsao G et al. A randomized, prospective, double-blind, placebo-controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology 2008; 134 (5): 1360–1368. doi: 10.1053/j.gastro.2008.02. 014.

23. Martín-Llahí M, Pépin MN, Guevara M et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology 2008; 134 (5): 1352–1359. doi: 10.1053/j.gastro.2008.02. 024.

24. Cavallin M, Kamath PS, Merli M et al. Terlipressin plus albumin versus midodrine and octreotide plus albumin in the treatment of hepatorenal syndrome: a randomized trial. Hepatology 2015; 62 (2): 567–574. doi: 10.1002/hep.27709.

25. Gluud LL, Christensen K, Christensen E et al. Terlipressin for hepatorenal syndrome. Cochrane Database Syst Rev 2012; 9: CD005162. doi: 10.1002/14651858.CD005162.pub3.

26. Alessandria C, Ozdogan O, Guevara M et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology 2005; 41 (6): 1282–1289.

27. Alessandria C, Venon WD, Marzano A et al. Renal failure in cirrhotic patients: role of terlipressin in clinical approach to hepatorenal syndrome type 2. Eur J Gastroenterol Hepatol 2002; 14 (12): 1363–1368.

28. Restuccia T, Ortega R, Guevara M et al. Effects of treatment of hepatorenal syndrome before transplantation on posttransplantation outcome. A case control study. J Hepatol 2004; 40 (1): 140–146.

29. Ginès P, Cardenas A. The management of ascites and hyponatremia in cirrhosis. Semin Liver Dis 2008; 28 (1): 43–58. doi: 10.1055/s-2008-1040 320.