IDDF2024-ABS-0397 Safety of stopping non-selective beta-blockers (NSBBs) according to baveno VII consensus in patients with cirrhosis and well-controlled liver disease aetiology

Background Baveno VII consensus suggests discontinuing NSBBs in patients with cirrhosis and controlled primary aetiological factor if liver stiffness measurement (LSM) is <25 kPa and endoscopy no longer shows any varices. We evaluated the safety of this recommendation. Methods Patients who underwent vibration-controlled transient elastography (VCTE) at Prince of Wales Hospital from Aug 2005 to Dec 2022 were included. The baseline date was the first date of stopping NSBB or a random date after VCTE for NSBB continuous users and non-users. Patients with hepatocellular carcinoma or hepatic decompensation before or <180 days after baseline were excluded. NSBB use referred to ≥28 days of cumulative use with ≥2 prescriptions. Stopping NSBB referred to ≥28 days of cessation without a subsequent prescription. Patients were followed until hepatic decompensation, death, or restarting NSBB for those who stopped, whichever earlier; non-liver-related death was a competing event. Results Among 4,748 patients (mean age 55.1 years, 45.2% females, mean LSM 7.1 kPa, 37.7% viral hepatitis, 41.4% metabolic dysfunction-associated steatotic liver disease), 77 (1.6%) developed hepatic decompensation at a median (IQR) follow-up of 4.4 (2.0-9.5) years. Among 4,464 NSBB non-users, 110 continuous users, and 174 patients who stopped NSBB, 57, 18, and 2 developed hepatic decompensation, respectively; the corresponding 5-year cumulative incidence (95% CI) was 1.3% (1.0%-1.7%), 18.9% (11.3%-27.9%), and 1.5% (0.1%-7.2%) (IDDF2024-ABS-0397 Figure 1). Compared to NSBB non-users, patients who stopped NSBB had a similar risk of hepatic decompensation (cause-specific hazard ratio [CSHR] 1.08 [95% CI 0.26-4.47]), while NSBB continuous users had a higher risk (3.40 [1.98-7.94]). Similar results were shown among 680 patients with LSM ≥10 kPa (CSHR [95% CI] 0.71 [0.10-5.33] for patients who stopped NSBB vs NSBB non-users). Patients with LSM ≥10 kPa fulfilling Baveno VII criteria had a comparable risk of hepatic decompensation (1.25 [0.44-3.54]) to those with LSM <10 kPa (IDDF2024-ABS-0397 Table 1). Conclusions Patients with cirrhosis and removed/suppressed primary aetiological factors may safely stop NSBBs. Their subsequent risk of hepatic decompensation is similar to those who did not require NSBBs.