Improving primary prophylaxis of variceal bleeding by adapting therapy to the clinical stage of cirrhosis. A competing-risk meta-analysis of individual participant data

Villanueva, Càndid; Sapena, Victor; Lo, Gin-Ho; Seo, Yeon Seok; Shah, Hasnain Ali; Singh, Virendra; Tripathi, Dhiraj; Schepke, Michael; Gheorghe, Cristian; Bonilha, Daniell Q; Jutabha, Rome; Wang, Huay-Min; Rodrigues, Susana G; Brujats, Anna; Lee, Han Ah; Azam, Zahid; Kumar, Pramod; Hayes, Peter C; Sauerbruch, Tilman; Chen, Wen-Chi; Iacob, Speranta; Libera, Ermelindo D; Jensen, Dennis M; Alvarado, Edilmar; Torres, Ferran; Bosch, Jaume

Abstract

Of 25 RCTs eligible, 14 failed to provide IPD and 11 were included, comprising 1400 patients (656 compensated, 744 decompensated), treated with NSBBs (N = 625), EVL (N = 546) or NSBB+EVL (N = 229). Baseline characteristics were similar between groups. Overall, mortality risk was similar with EVL vs. NSBBs (subdistribution hazard-ratio (sHR) = 1.05, 95% CI = 0.75-1.49) and with EVL + NSBBs vs either monotherapy, with low heterogeneity (I2 = 28.7%). In compensated patients, mortality risk was higher with EVL vs NSBBs (sHR = 1.76, 95% CI = 1.11-2.77) and not significantly lower with NSBBs+EVL vs NSBBs, without heterogeneity (I2 = 0%). In decompensated patients, mortality risk was similar with EVL vs. NSBBs and with NSBBs+EVL vs. either monotherapy.

Citation

Villanueva C, Sapena V, Lo GH, Seo YS, Shah HA, Singh V, Tripathi D, Schepke M, Gheorghe C, Bonilha DQ, Jutabha R, Wang HM, Rodrigues SG, Brujats A, Lee HA, Azam Z, Kumar P, Hayes PC, Sauerbruch T, Chen WC, Iacob S, Libera ED, Jensen DM, Alvarado E, Torres F, Bosch J; Baveno Cooperation-a EASL Consortium. Improving primary prophylaxis of variceal bleeding by adapting therapy to the clinical stage of cirrhosis. A competing-risk meta-analysis of individual participant data. Aliment Pharmacol Ther. 2024 Feb;59(3):306-321. doi: 10.1111/apt.17824. Epub 2023 Dec 18.

Type

Article