Presentations in Hepatology: Efficacy of Rifaximin in Patients With Minimal HE

6 Aug
2010

It has been suggested that the minimal absorption associated with rifaximin may make the agent more conducive for long-term use than other antibiotics, which are more readily absorbed and associated with significant side effects. Grande and colleagues conducted a double-blind crossover trial evaluating the use of rifaximin in patients with liver cirrhosis and minimal HE. A total of 17 patients were randomly assigned to rifaximin administered at 1,200 mg/day (2 200-mg tablets given every 8 hours), or placebo, for 4 weeks. After a 4-week washout period, patients received the alternative treatment (rifaximin or placebo) for the next 4 weeks. In this interim analysis, rifaximin was associated with a significant improvement in the area under the curve of glutamine oral challenge compared to placebo (-52.3±53 mg/mL/hr vs -5.62±10.56 mg/mL/hr; P=.045) in the first phase of the study but not the second phase of the study. However, rifaximin was associated with an improvement over placebo in the Psychometric Hepatic Encephalo-pathy Score in the second phase of the study (2±1.75 vs -1±1.15; P=.05).

Kinetics of HBsAg Loss With TDF and Factors Associated With HBsAg Loss

Gane and colleagues presented an analysis of the kinetics of HBsAg decay in HBeAg-positive patients from Study 103. Among patients attaining HBsAg loss with TDF, HBsAg levels declined rapidly in the first 48 weeks of treatment, with median reductions of 1.01, 2.41, and 4.85 log10 IU/mL, respectively, at Weeks 12, 24, and 48. Median HBsAg reductions at the same time points in patients not attaining HBsAg loss were 0.17, 0.20, and 0.28 log10 IU/mL, respectively. The investigators identified several demographic factors and disease characteristics that were significantly associated with HBsAg loss. At baseline, median HBsAg level was significantly higher in patients with HBsAg loss than those not attaining HBsAg loss (5.11 vs 4.50 log10 IU/mL; P<.001), and patients with HBsAg loss were significantly more likely than other patients to have an HBsAg of at least 4.5 log10 IU/mL (100% vs 48%). HBV genotype was also a significant predictor of HBsAg loss (P<.001). Genotype A/D was present in 12 of 13 evaluated patients with HBsAg loss compared to 82 of 158 patients without HBsAg loss. Baseline median HBV DNA level was also higher in patients with HBsAg loss (P=.003), as was median ALT (P=.043). Finally, there was a trend toward an association between baseline Knodell necroinflammatory score and likelihood of HBsAg loss. Overall, HBsAg loss by Year 3 was observed in 14% of patients with a baseline HBsAg of at least 4.5 log10 IU/mL, 13% of patients with genotype A/D, 16% of patients with an HBV DNA level of at least 9 log10 copies/mL, and 10% of patients with a Knodell necroinflammatory score of at least 9.
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