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The effect of carvedilol and propranolol on portal hypertension in patients with cirrhosis: a meta-analysis.

Chen S, Wang JJ, Wang QQ, Hu JW, Dong S, Hu LJ, Jian YC, Liu XY, Yang GM, Xiong WJ - Patient Prefer Adherence (2015)

Bottom Line: Significant heterogeneity (P<0.1, I (2)=92%) existed between the two treatment groups in %MAP reduction.No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.Carvedilol has a greater portal hypertensive effect than propranolol.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, People's Republic of China.

ABSTRACT

Purpose: Several randomized controlled clinical trials have been conducted to investigate the role of carvedilol and propranolol on the effect of portal pressure in patients with cirrhosis, leading to controversial results. Current meta-analysis was performed to compare the efficacy of the two drugs on portal pressure.

Patients and methods: Two-hundred and ninety eligible patients were recruited. Published studies were selected based on PubMed, the Cochrane Library, Chinese Journal Full-text Database, and Wanfang Database. The outcome measurements included the mean difference (MD) in the percentage of hepatic vein pressure gradient reduction (%HVPG reduction), the risk ratio (RR) of nonresponders in hemodynamic assessment, and the percentage of mean arterial pressure reduction (%MAP reduction). Subgroup analysis was performed.

Results: Seven trials were identified (including five acute and three long-term drug administration randomized controlled trials). A summary of pooled MD between the %HVPG reduction is as follows: overall -8.62 (confidence interval [CI] -11.76, -5.48, P<0.00001), acute -10.05 (CI -14.24, -5.86, P<0.00001), and long term -6.80 (CI -11.53, -2.07, P=0.005), while summary of pooled RR of hemodynamic nonresponders with carvedilol was as follows: overall 0.64 (CI 0.51, 0.81, P=0.0002), acute 0.63 (CI 0.47, 0.85, P=0.002), and long term 0.67 (CI 0.47, 0.97, P=0.03). Both of the outcome measurements favored carvedilol. Significant heterogeneity (P<0.1, I (2)=92%) existed between the two treatment groups in %MAP reduction. No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.

Conclusion: Carvedilol has a greater portal hypertensive effect than propranolol. Further comparative trials of the two drugs are required to identify the effect of MAP reduction.

No MeSH data available.


Related in: MedlinePlus

Subgroup analysis (fixed-effect model) of hemodynamic nonresponders, representing the RRs (rectangles) and 95% CI (horizontal lines) for trials that compared carvedilol and propranolol.Notes: The size of the rectangles indicates the weight of every trial. The above diamond shows the subtotal RR and 95% CI of the acute drug administration. The below diamond shows the subtotal RR and 95% CI of the long-term drug administration. The heterogeneity test is also performed.Abbreviations: RRs, risk ratios; CI, confidence interval; M–H, Mantel–Haenszel; HVPG, hepatic vein pressure gradient.
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f5-ppa-9-961: Subgroup analysis (fixed-effect model) of hemodynamic nonresponders, representing the RRs (rectangles) and 95% CI (horizontal lines) for trials that compared carvedilol and propranolol.Notes: The size of the rectangles indicates the weight of every trial. The above diamond shows the subtotal RR and 95% CI of the acute drug administration. The below diamond shows the subtotal RR and 95% CI of the long-term drug administration. The heterogeneity test is also performed.Abbreviations: RRs, risk ratios; CI, confidence interval; M–H, Mantel–Haenszel; HVPG, hepatic vein pressure gradient.

Mentions: The pooled RR of hemodynamic nonresponse with carvedilol was 0.64 (CI 0.51–0.81; fixed-effect model), underlining superiority of carvedilol in responder rate (Z=3.71, P=0.0002). No heterogeneity was found (P=0.83; I2=0%) (Figure 5).


The effect of carvedilol and propranolol on portal hypertension in patients with cirrhosis: a meta-analysis.

Chen S, Wang JJ, Wang QQ, Hu JW, Dong S, Hu LJ, Jian YC, Liu XY, Yang GM, Xiong WJ - Patient Prefer Adherence (2015)

Subgroup analysis (fixed-effect model) of hemodynamic nonresponders, representing the RRs (rectangles) and 95% CI (horizontal lines) for trials that compared carvedilol and propranolol.Notes: The size of the rectangles indicates the weight of every trial. The above diamond shows the subtotal RR and 95% CI of the acute drug administration. The below diamond shows the subtotal RR and 95% CI of the long-term drug administration. The heterogeneity test is also performed.Abbreviations: RRs, risk ratios; CI, confidence interval; M–H, Mantel–Haenszel; HVPG, hepatic vein pressure gradient.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508063&req=5

f5-ppa-9-961: Subgroup analysis (fixed-effect model) of hemodynamic nonresponders, representing the RRs (rectangles) and 95% CI (horizontal lines) for trials that compared carvedilol and propranolol.Notes: The size of the rectangles indicates the weight of every trial. The above diamond shows the subtotal RR and 95% CI of the acute drug administration. The below diamond shows the subtotal RR and 95% CI of the long-term drug administration. The heterogeneity test is also performed.Abbreviations: RRs, risk ratios; CI, confidence interval; M–H, Mantel–Haenszel; HVPG, hepatic vein pressure gradient.
Mentions: The pooled RR of hemodynamic nonresponse with carvedilol was 0.64 (CI 0.51–0.81; fixed-effect model), underlining superiority of carvedilol in responder rate (Z=3.71, P=0.0002). No heterogeneity was found (P=0.83; I2=0%) (Figure 5).

Bottom Line: Significant heterogeneity (P<0.1, I (2)=92%) existed between the two treatment groups in %MAP reduction.No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.Carvedilol has a greater portal hypertensive effect than propranolol.

View Article: PubMed Central - PubMed

Affiliation: Department of Hepatology, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, People's Republic of China.

ABSTRACT

Purpose: Several randomized controlled clinical trials have been conducted to investigate the role of carvedilol and propranolol on the effect of portal pressure in patients with cirrhosis, leading to controversial results. Current meta-analysis was performed to compare the efficacy of the two drugs on portal pressure.

Patients and methods: Two-hundred and ninety eligible patients were recruited. Published studies were selected based on PubMed, the Cochrane Library, Chinese Journal Full-text Database, and Wanfang Database. The outcome measurements included the mean difference (MD) in the percentage of hepatic vein pressure gradient reduction (%HVPG reduction), the risk ratio (RR) of nonresponders in hemodynamic assessment, and the percentage of mean arterial pressure reduction (%MAP reduction). Subgroup analysis was performed.

Results: Seven trials were identified (including five acute and three long-term drug administration randomized controlled trials). A summary of pooled MD between the %HVPG reduction is as follows: overall -8.62 (confidence interval [CI] -11.76, -5.48, P<0.00001), acute -10.05 (CI -14.24, -5.86, P<0.00001), and long term -6.80 (CI -11.53, -2.07, P=0.005), while summary of pooled RR of hemodynamic nonresponders with carvedilol was as follows: overall 0.64 (CI 0.51, 0.81, P=0.0002), acute 0.63 (CI 0.47, 0.85, P=0.002), and long term 0.67 (CI 0.47, 0.97, P=0.03). Both of the outcome measurements favored carvedilol. Significant heterogeneity (P<0.1, I (2)=92%) existed between the two treatment groups in %MAP reduction. No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.

Conclusion: Carvedilol has a greater portal hypertensive effect than propranolol. Further comparative trials of the two drugs are required to identify the effect of MAP reduction.

No MeSH data available.


Related in: MedlinePlus