Simvastatin and Rifaximin in Decompensated Cirrhosis: A Randomized Clinical Trial.

• Tác giả: Juan G Abraldes, Carlo Alessandria, Andrew S Allegretti, Sonia Alonso, Paolo Angeli, Xavier Ariza, Rafael Bañares, Ulrich Beuers, Daniela Campion, Paolo Caraceni, Marta Carol, Berta Cuyàs, Koos de Wit, Gemma Domenech, Núria Fabrellas, Claire Francoz, Kohilan Gananandan, Pere Ginès, Jordi Gratacós-Ginès, Isabel Graupera, Rubén Hernáez, César Jiménez, María Joyera, Adrià Juanola, Patrick S Kamath, Wim Laleman, Ann T Ma, Claudia Martell, Rajeshwar P Mookerjee, Manuel Morales-Ruiz, Laura Napoleone, Martina Pérez-Guasch, Salvatore Piano, Judit Pich, Enrico Pompili, Elisa Pose, José Ríos, Olivier Roux, Jordi Sánchez-Delgado, Miquel Serra-Burriel, Elsa Solà, Cristina Solé, Germán Soriano, Marta Tonon, Ferrán Torres, Jonel Trebicka, Frank Erhard Uschner, Víctor M Vargas, Hugh Watson, Giacomo Zaccherini
• Ngôn ngữ: eng
• Ký hiệu phân loại: 232.962 Trial and condemnation
• Thông tin xuất bản: United States : JAMA , 2025
• Bộ sưu tập: NCBI
• ID: 690380

Tóm tắt

 IMPORTANCE: There are no useful treatments to prevent the development of severe complications of liver cirrhosis. Simvastatin and rifaximin have shown beneficial effects in liver cirrhosis. OBJECTIVE: To assess whether simvastatin combined with rifaximin improves outcomes in patients with decompensated cirrhosis. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, placebo-controlled, phase 3 trial conducted among patients with decompensated cirrhosis in 14 European hospitals between January 2019 and December 2022. The last date of follow-up was December 2022. INTERVENTIONS: Patients were randomly assigned to receive simvastatin, 20 mg/d, plus rifaximin, 1200 mg/d (n = 117), or identical-appearing placebo (n = 120) for 12 months in addition to standard therapy, stratified according to Child-Pugh class B or C. MAIN OUTCOMES AND MEASURES: The primary end point was incidence of severe complications of liver cirrhosis associated with organ failure meeting criteria for acute-on-chronic liver failure. Secondary outcomes included transplant or death and a composite end point of complications of cirrhosis (ascites, hepatic encephalopathy, variceal bleeding, acute kidney injury, and infection). RESULTS: Among the 237 participants randomized (Child-Pugh class B: n = 194
  Child-Pugh class C: n = 43), 72% were male and the mean age was 57 years. There were no differences between the 2 groups in terms of development of acute-on-chronic liver failure (21 [17.9%] vs 17 [14.2%] patients in the treatment and placebo groups, respectively
  hazard ratio, 1.23
  95% CI, 0.65-2.34
  P = .52)
  transplant or death (22 [18.8%] vs 29 [24.2%] patients in the treatment and placebo groups, respectively
  hazard ratio, 0.75
  95% CI, 0.43-1.32
  P = .32)
  or development of complications of cirrhosis (50 [42.7%] vs 55 [45.8%] patients in the treatment and placebo groups, respectively
  hazard ratio, 0.93
  95% CI, 0.63-1.36
  P = .70). Incidence of adverse events was similar in both groups (426 vs 419
  P = .59), but 3 patients in the treatment group (2.6%) developed rhabdomyolysis. CONCLUSIONS AND RELEVANCE: The addition of simvastatin plus rifaximin to standard therapy does not improve outcomes in patients with decompensated liver cirrhosis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03780673.