More than half of NASH patients respond to HVPG-guided NSBB prophylaxis

Hepatic venous pressure gradient (HVPG)-guided prophylaxis with non-selective beta blockers (NSBB) seems to be reasonably effective in patients with nonalcoholic steatohepatitis (NASH), eliciting responses from around half of this population, a recent study has found.

Researchers enrolled 38 patients with NASH cirrhosis and varices who received HPVG-guided NSBB treatment. HVPG-response, defined as a drop to below 12 mm Hg or by ≥10-percent from baseline, was assessed within a median of 52 days after enrolment. The study endpoint was a composite of variceal bleeding, liver-related death, decompensation, large volume paracentesis (LVP), and hospital admission for grade III–IV hepatic encephalopathy.

Over a median follow-up of 16.9 months, the researchers documented the primary endpoint in 19 patients (50 percent), including two with variceal bleeding, two with liver-related deaths, and five admissions for hepatic encephalopathy.

Twenty-one patients showed response to HPVG-guided NSBB treatment, yielding a rate of 55.3 percent. Responders received comparable doses of NSBB than nonresponders and had similar model for end-stage liver disease scores. In contrast, diabetes mellitus was significantly more common among nonresponders (82.4 percent vs 52.4 percent; p=0.05).

Multivariable binary logistic regression analysis confirmed that diabetes mellitus was indeed an independent and significant negative predictor of NSBB response (odds ratio [OR], 0.16, 95 percent confidence interval [CI], 0.03–0.91; p=0.038).

Meanwhile, higher mean arterial pressure correlated with better NSBB response (OR per 1 mm Hg, 1.07, 95 percent CI, 1.02–1.15; p=0.044).