Shortened terlipressin therapy after endoscopic haemostasis as effective as 3-day course

In cirrhosis patients with acute variceal bleeding (AVB), treatment with terlipressin for a single day yields similar rebleeding and mortality rates as 3-day treatment following endoscopic haemostasis, while having an overall superior safety profile, according to a study.

A total of 150 patients were randomly assigned to receive either 1 day (n=75) or 3 days (n=75) of terlipressin therapy postendoscopic intervention. The primary outcome was rebleeding at 5 days, while the secondary outcomes included rebleeding and mortality rates at 6 weeks.

One patient from 1-day arm was excluded, leaving 149 patients in the modified intention-to-treat analysis. Baseline patient characteristics were similar in the two treatment arms.

Rebleeding at day 5 occurred in three patients in the 1-day arm and in four patients in the 3-day arm (4.1 percent vs 5.3 percent), with no significant between-group difference (p=0.726).

Likewise, the rates of other outcomes were similar in the 1-day and 3-day arms. Specifically, 5-day mortality rates were 1.4 percent and 1.3 percent (p=0.960), respectively. Rebleeding at day 42 occurred in nine and 10 patients (12.2 percent vs 13.3 percent; p=0.842), while mortality rates at day 42 were 6.8 percent vs 5.3 percent (p=0.704), respectively.

As for safety, the frequency of adverse effects was significantly lower in the 1-day terlipressin therapy arm than in the 3-day arm (37.8 percent vs 56 percent; p=0.026).