Carvedilol reduces decompensation, death in cirrhosis patients with hypertension

Long-term treatment with carvedilol lowers the risk of decompensation of cirrhosis and improves survival in compensated patients with clinically significant portal hypertension (CSPH), reports a study.

“This suggests that screening patients with compensated cirrhosis for CSPH to enable the prompt initiation of carvedilol could improve outcomes,” the researchers said.

A systematic review was conducted to identify randomized controlled trials (RCTs) comparing carvedilol with control therapy (no active treatment or endoscopic variceal ligation [EVL]) in patients with cirrhosis and CSPH without previous bleeding.

The researchers performed a competing-risk time-to-event meta-analysis using individual patient data (IPD) obtained from principal investigators of RCTs. They only included compensated patients in the analysis. Models were adjusted using propensity scores for baseline covariates with the inverse probability of treatment weighting (IPTW) approach.

Of the 125 full-text studies identified, four RCTs met the eligibility criteria. These trials provided IPD and included 352 patients with compensated cirrhosis, 181 treated with carvedilol and 171 controls (79 received EVL and 92 placebo). Baseline characteristics were comparable between groups.

Standardized differences were <10 percent by IPTW.

Patients treated with carvedilol had a lower risk of developing decompensation of cirrhosis than controls (subdistribution hazard ratio [SHR], 0.506, 95 percent confidence interval [CI], 0.289‒0.887; p=0.017; I², 0.0 percent; Q-statistic-p=0.880), mainly due to a reduced risk of ascites (SHR, 0.491, 95 percent CI, 0.247‒0.974; p=0.041; I², 0.0 percent; Q-statistic-p=0.384).

In addition, mortality risk was lower with carvedilol than placebo (SHR, 0.417, 95 percent CI, 0.194‒0.896; p=0.025; I², 0.0 percent; Q-statistic-p=0.989).

“The transition from compensated cirrhosis to decompensated cirrhosis is associated with markedly reduced life expectancy,” the researchers said. “Therefore, preventing decompensation in patients with compensated cirrhosis would be associated with greatly improved patient outcomes.”