*EMBARGOED All research presented at the 2024 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Sunday, October 27, 2024, at 12:00 pm ET.
Oral 9 – Rifaximin Monotherapy Is More Effective Than Lactulose Monotherapy for Reducing the Risk of Overt Hepatic Encephalopathy (OHE) Recurrence and All-Cause Mortality: An Analysis of Two Randomized Trials
Monday, October 28, 2024 | 10:06 AM – 10:18 AM ET | Terrace Ballroom
Author Insight from Jasmohan S. Bajaj, MD, MS, FACG
What’s new here and important for clinicians?
It is recommended that patients with cirrhosis who have previously had an episode of overt hepatic encephalopathy (OHE) receive preventive treatment to reduce the risk of recurrence. Frequently, after an episode is treated, lactulose is prescribed as secondary prophylaxis, with rifaximin added to lactulose therapy when additional OHE episodes occur. However, there are tolerability and adherence issues associated with lactulose use. This post hoc analysis demonstrated that rifaximin monotherapy for 6 months was well tolerated and significantly more effective than lactulose monotherapy for reducing the risk of an OHE episode in patients with cirrhosis and a history of OHE. As well, rifaximin monotherapy may confer a survival benefit versus lactulose monotherapy. Therefore, rifaximin monotherapy may be an appropriate management approach for certain patients.
What do patients need to know?
Patients with cirrhosis should be aware that if they have been diagnosed with hepatic encephalopathy (HE) previously, they should discuss with their health care provider the use of prophylaxis to reduce the risk of additional episodes. Adherence to treatment is critical; if adverse effects or tolerability issues with current therapy, such as lactulose, are negatively impacting adherence and/or the patient’s health-related quality of life, this study supports the availability of an alternative treatment approach. Compared with lactulose monotherapy, rifaximin monotherapy significantly reduced the risk of getting another episode of overt HE during 6 months of treatment.
Author Contact
Jasmohan S. Bajaj, MD, MS, FACG
Virginia Commonwealth University School of Medicine
Richmond, VA
jasmohan.bajaj [at] vcuhealth.org
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