Carvedilol versus endoscopic band ligation for secondary prophylaxis of variceal bleeding-long-term follow-up of a randomised control trial
Dunne, Philip D J Young, David Chuah, Cher Shiong Hayes, Peter C Tripathi, Dhiraj Leithead, Joanna Smith, Lyn A Gaya, Daniel R Forrest, Ewan Stanley, Adrian J
Dunne, Philip D J
Young, David
Chuah, Cher Shiong
Hayes, Peter C
Tripathi, Dhiraj
Leithead, Joanna
Smith, Lyn A
Gaya, Daniel R
Forrest, Ewan
Stanley, Adrian J
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2022-03-24
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Abstract
Background and aims: Carvedilol reduces rates of variceal bleeding and rebleeding by lowering portal pressure. However, an associated pleiotropic survival benefit has been proposed. We aimed to assess long-term survival in a cohort of patients previously randomised to receive either carvedilol or endoscopic band ligation (EBL) following oesophageal variceal bleeding (OVB).
Methods: The index study randomised 64 cirrhotic patients with OVB between 2006 and 2011 to receive either carvedilol or EBL. Follow-up was undertaken to April 2020 by review of electronic patient records. The primary outcome was survival. Other outcomes including variceal rebleeding and liver decompensation events were compared.
Results: 26 out of 33 participants received carvedilol in the follow-up period and 28 out of 31 attended regular EBL sessions. The median number of follow-up days for all patients recruited was 1459 (SE = 281.74). On the intention to treat analysis, there was a trend towards improved survival in the carvedilol group (p = 0.09). On per-protocol analysis, carvedilol use was associated with improved long-term survival (p = 0.005, HR 3.083, 95% CI 1.397-6.809), fewer liver-related deaths (0% vs 22.57%, p = 0.013, OR ∞, 95%CI 1.565-∞) and fewer admissions with decompensated liver disease (12% vs 64.29%, p = 0.0002, OR 13.2, 95% CI 3.026-47.23) compared to the EBL group. There was no statistically significant difference in variceal rebleeding rates.
Conclusion: Following OVB in cirrhotic patients, carvedilol use is associated with survival benefit, fewer liver-related deaths and fewer hospital admissions with decompensated liver disease. Further studies are needed to validate this finding.
Citation
Dunne PDJ, Young D, Chuah CS, Hayes PC, Tripathi D, Leithead J, Smith LA, Gaya DR, Forrest E, Stanley AJ. Carvedilol versus endoscopic band ligation for secondary prophylaxis of variceal bleeding-long-term follow-up of a randomised control trial. Aliment Pharmacol Ther. 2022 Jun;55(12):1581-1587. doi: 10.1111/apt.16901. Epub 2022 Mar 24
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