TLM 2023: Use of rifaximin significantly reduced mean number of OHE episodes as well as hospital contacts, including ED visits and admissions.
Recurrent episodes of hepatic encephalopathy (HE) and associated health care expenditures were significantly reduced among individuals prescribed rifaximin (Xifaxan, Salix Pharmaceuticals) as secondary prophylaxis for the complication of advanced liver disease, according to study findings presented during an oral abstract session at the American Association of Liver Disease’s annual scientific conference, The Liver Meeting, 2023, November 10-14, 2023, in Boston, MA.
The broad-spectrum antibiotic is approved and guideline-recommended for secondary prevention of HE, according to presenting author Diederick van Doorn, MD, PhD, and colleagues, but they add there are few real-world data on its efficacy and impact on health care utilization.
To investigate further, Doorn et al conducted a retrospective cohort study from March 2010 to May 2023, comprised of patients from 7 hospitals in The Netherlands, who were prescribed rifaximin for secondary prophylaxis of HE. Data were collected and compared for the 6 months preceding and following a prescription for rifaximin. The authors’ primary outcome of interest was overall survival (OS). Secondary outcomes included the impact of rifaximin on the frequency and duration of hospital admissions, as well as emergency department visits for cirrhosis-related complications. Healthcare utilization was defined as any form of hospital contact.
The study cohort numbered 108 participants (65% men, median age 67.5 years). The median MELD (Model for End-stage Liver Disease) score at baseline was 15. The most common etiology of cirrhosis (52%) was alcoholic liver disease. The median follow-up duration after the initiation of rifaximin was 62 months (95% CI, 51-73 months), during which 63% of the patients died. The median OS was 24 months (95% CI, 8.9-39 months).
After rifaximin treatment, the mean number of episodes of HE per patient decreased from 2.2 to 0.96 (P<.001). Health care utilization also decreased significantly, with the number of hospital contacts falling from 5.5 in the 6 months before rifaximin to 3 contacts during the 6 months after rifaximin (P<.001).
Further, while the mean length of hospital stay was unchanged, the authors reported a decrease in the mean number of hospital admissions per patient from 1.7 before rifaximin to 1.0 after starting rifaximin (P=.001). There were also fewer outpatient visits, with the mean number of visits per patient decreasing from 2.4 to 1.8 (P=.004). Emergency department presentations without subsequent admission decreased from 0.35 to 0.17 (P=.039) per patient.
These findings strongly suggest that use of rifaximin for secondary prophylaxis of HE significantly reduces the number of recurrent episodes and consequently overall use of health care resources, including ted including fewer hospital admissions as well as ED and outpatient visits.