MONDAY, Oct. 28, 2024 (HealthDay News) — For patients with a history of overt hepatic encephalopathy (OHE), rifaximin monotherapy (MT) results in significantly fewer OHE episodes than lactulose (LAC) MT, according to a study presented at the annual meeting of the American College of Gastroenterology, held from Oct. 25 to 30 in Philadelphia.

Jasmohan S. Bajaj, M.D., from Virginia Commonwealth University in Richmond, and colleagues examined the efficacy/safety of LAC MT versus rifaximin MT using data from two randomized trials of adults with cirrhosis and a history of OHE during the previous six months. The analyses included only patients treated with rifaximin 550 mg twice daily (no LAC) or LAC (titrated to two to three soft stools/day; 125 and 145 patients, respectively).

The researchers found that the percentage of patients with an OHE episode was significantly smaller for those treated with rifaximin MT versus LAC MT (23.2 versus 49.0 percent). During six months of treatment, rifaximin MT reduced the risk for a breakthrough OHE episode by 60 percent versus LAC MT, with a number needed to treat of four. The mortality rate was lower for rifaximin MT versus LAC MT (1.6 versus 4.8 percent), with a number needed to treat of 19 (hazard ratio, 0.048). Mortality was reported for 1.6 and 6.9 percent of patients in the rifaximin and LAC MT groups, respectively, through follow-up. More patients in the LAC versus rifaximin group discontinued early from the study (62.1 versus 36.0 percent), most often due to recurrence of HE.

“Rifaximin MT may be an appropriate management approach in select patient populations,” the authors write.

Several authors disclosed ties to pharmaceutical companies, including Salix Pharmaceuticals, which manufactures rifaximin.

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