Rifaximin prevents post-TIPS overt hepatic encephalopathy

Use of rifaximin is well tolerated and lowers the risk of overt hepatic encephalopathy in patients with cirrhosis treated with transjugular intrahepatic portosystemic shunt (TIPS), a recent study has shown.

The investigators conducted a randomized, double-blind, multicentre, placebo-controlled trial to determine whether rifaximin prevented overt hepatic encephalopathy after TIPS relative to placebo. A total of 197 patients with cirrhosis undergoing TIPS for intractable ascites or prevention of variceal rebleeding were randomly assigned to receive rifaximin (600 mg twice daily) or placebo, beginning 14 days before TIPS and continuing for 168 days after the procedure.

The proportion of patients with an episode of overt hepatic encephalopathy was lesser in the rifaximin group (n=93; 34 percent, 95 percent confidence interval [CI], 25–44 percent) than in the placebo group (n=93; 53 percent, 95 percent CI, 43–63 percent) during the postprocedure period (odds ratio, 0.48, 95 percent CI, 0.27–0.87). No significant between-group difference was noted in the incidence of adverse events or transplant-free survival.

These findings indicate that rifaximin should be considered for prophylaxis of post-TIPS hepatic encephalopathy, according to the investigators.

The study had certain limitations. For instance, its conclusion was applicable mainly to patients with alcoholic cirrhosis, who made up the study population. In addition, the potential benefit of rifaximin 6 months after TIPS and beyond warranted further investigation.