Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trial

• Published in: Journal of hepatology 2003, Vol.38 (1), p.51-58
• Main Authors: Mas, Antoni, Rodés, Juan, Sunyer, Lourdes, Rodrigo, Luı́s, Planas, Ramon, Vargas, Victor, Castells, Lluı́s, Rodrı́guez-Martı́nez, Dolores, Fernández-Rodrı́guez, Conrado, Coll, Ignasi, Pardo, Albert
• Format: Article
• Language: English
• Subjects: Acute Disease; Ammonia - blood; Anti-Infective Agents - therapeutic use; Biological and medical sciences; Cirrhosis; Double-Blind Method; Electroencephalography; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatic encephalopathy; Hepatic Encephalopathy - blood; Hepatic Encephalopathy - drug therapy; Hepatic Encephalopathy - physiopathology; Humans; Lactitol; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Recurrence; Rifamycins - therapeutic use; Rifaximin; Severity of Illness Index; Sugar Alcohols - therapeutic use; Treatment Outcome
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(02)00350-1

Background/Aims: The efficacy and safety of rifaximin in comparison with lactitol in the treatment of acute hepatic encephalopathy was assessed in a prospective randomized, double-blind, double-dummy, controlled trial. Methods: A total of 103 patients with grade I–III acute hepatic encephalopathy were randomized to receive rifaximin (50 patients, 1200 mg/day) or lactitol (53 patients, 60 g/day) for 5–10 days. Changes in the portal-systemic encephalopathy (PSE) index on entry and at the end of the study were used to evaluate the efficacy of the two therapies. Results: Both groups were comparable before treatment with regard to demographic data and characteristics of the hepatic encephalopathy episode. The global efficacy of both therapies was similar: 81.6% in the rifaximin group and 80.4% in the lactitol group showed improvement or total regression of the episode. A significantly better evolution of the PSE index was observed in the rifaximin group, due to a greater effect of rifaximin in two components of the index: EEG abnormalities and ammonia levels. No serious adverse events related to either treatment were found during the study. Conclusions: Rifaximin may be considered a useful and safe alternative therapy to lactitol in the treatment of acute hepatic encephalopathy in cirrhosis.