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Thématique :
- Foie
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2016/03  
 
  2016 Mar;63(3):983-92.  
  doi: 10.1002/hep.28396  
 
  Terlipressin given by continuous intravenous infusion versus intravenous boluses in the treatment of hepatorenal syndrome: A randomized controlled study.  
 
  Cavallin M, Piano S, Romano A, Fasolato S, Frigo AC, Benetti G, Gola E, Morando F, Stanco M, Rosi S, Sticca A, Cillo U, Angeli P  
  http://www.ncbi.nlm.nih.gov/pubmed/26659927  
 
 

In patients with cirrhosis and hepatorenal syndrome (HRS), terlipressin has been used either as continuous intravenous infusion or as intravenous boluses. To date, these two approaches have never been compared. The goal of this study was to compare the administration of terlipressin as continuous intravenous infusion versus intravenous boluses in the treatment of type 1 HRS. Seventy-eight patients were randomly assigned to receive either continuous intravenous infusion (TERLI-INF group) at the initial dose of 2 mg/day or intravenous boluses of terlipressin (TERLI-BOL group) at the initial dose of 0.5 mg every 4 hours. In case of no response, the dose was progressively increased to a final dose of 12 mg/day in both groups. Albumin was given at the same dose in both groups (1 g/kg of body weight at the first day followed by 20-40 g/day). Complete response was defined by decrease of serum creatinine (sCr) from baseline to a final value ≤133 μmol/L, partial response by a decrease ≥50% of sCr from baseline to a final value >133 μmol/L. The rate of adverse events was lower in the TERLI-INF group (35.29%) than in the TERLI-BOL group (62.16%, P < 0.025). The rate of response to treatment, including both complete and partial response, was not significantly different between the two groups (76.47% versus 64.85%; P value not significant). The mean daily effective dose of terlipressin was lower in the TERLI-INF group than in the TERLI-BOL group (2.23 ± 0.65 versus 3.51 ± 1.77 mg/day; P < 0.05).

CONCLUSION:

Terlipressin given by continuous intravenous infusion is better tolerated than intravenous boluses in the treatment of type 1 HRS. Moreover, it is effective at doses lower than those required for intravenous bolus administration. (Hepatology 2016;63:983-992).

 
Question posée
 
Comparer l’administration de terlipressine par perfusion IV continue versus bolus dans le traitement du syndrome hépato-rénal de type 1.
 
Question posée
 
68 patients ont été randomisés (groupe TERLI-INF avec dose initiale de 2 mg/j ou (groupeTERLI-BOL avec dose initiale de 0,5 mg/4 h. Le taux de réponse au traitement n’était pas significativement différents (76.47% versus 64.85%). La dose journalière efficace de terlipressine était plus faible dans le groupe TERLI-INF comparé au groupe TERLI-BOL (2.23 ± 0.65 vs 3.51 ± 1.77 mg/jour P < 0.05) expliquant la meilleure tolérance.
 
Commentaires

Pas d’hésitation, passez à la perfusion continue

 
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