— “Is it time to state main prophylaxis is dead?” one specialist asks
by Katherine Kahn,
Personnel Writer, MedPage Today
June 11, 2024
Rifaximin prophylaxis was no much better than placebo at avoiding deaths and other unfavorable results from spontaneous bacterial peritonitis (SBP) in clients with extreme cirrhosis, according to interim outcomes of the stage III ProPILA-Rifax trial.
In a customized intention-to-treat analysis, transplant-free survival after 12 months amongst French clients who took 550 mg of rifaximin two times daily was 58% compared to 65% for those who took a placebo (log-rank, P=0.39), Thierry Thévenot, MD, PhD, of the Centre Hospitalier Régional et Universitaire in Besançon, France, reported at the European Association for the Study of the Liver (EASL) yearly conference in Milan.
“Bacterial infections in cirrhotic clients represent the most essential speeding up occasion for severe decompensation and represent substantial death,” Thévenot informed guests. “One of the most typical infections observed worldwide is spontaneous bacterial peritonitis.” Antibiotic prophylaxis to avoid a very first episode of SBP is advised in really high-risk clients, it stays a subject of debate, he kept in mind.
After Thévenot and associates left out 33 cases of believed serious alcoholic liver disease from the associate, there was still no substantial distinction in transplant-free survival at 12 months in between rifaximin and placebo (log-rank, P=0.61)
First-event cumulative occurrence of hepatic encephalopathy, intestinal (GI) bleeding, and hepatorenal syndrome were comparable in between the 2 groups (Gray’s test, P=0.22) and when evaluated as private criteria, Thévenot informed participants.
The possibility of transplant-free survival was not considerably various in the treatment and placebo groups at both 3 months (log-rank, P=0.29) and 6 months (P=0.44).
Scientists likewise took a look at possibility of survival according to Model for End-Stage Liver Disease (MELD) rating, Child-Pugh rating, sex, and age. Once again, there were no substantial distinctions in treatment impacts from rifaximin according to these subgroups.
“Is it time to state main prophylaxis is dead?” Jasmohan Bajaj, MD, of the Virginia Commonwealth University and Richmond VA Medical Center, commented throughout a Q&A session. Bajaj was not related to the research study.
Bajaj included that his current research study carried out at VA centers discovered high rates of Escherichia coli resistance to ciprofloxacin amongst clients confessed for a very first SBP episode who had actually been recommended main prophylaxis. As a