Key result
Carvedilol was associated with a greater reduction in hepatic venous pressure gradient within 6 months compared to propranolol (mean difference -8.49; 95% CI -12.36 to -4.63).
Why the study?
Does carvedilol improve clinical and haemodynamic outcomes compared to other therapies in patients with cirrhosis and portal hypertension?
Meta-Analysis
Does carvedilol improve clinical and haemodynamic outcomes compared to other therapies in patients with cirrhosis and portal hypertension?
Carvedilol may be more effective than propranolol in reducing hepatic venous pressure gradient in patients with cirrhosis, though clinical outcomes like mortality and bleeding appear similar to other standard therapies.
May favor carvedilol over propranolol for HVPG reduction in cirrhosis; extends hemodynamic data while leaving clinical outcome benefits open.
OBJECTIVE: To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension. DESIGN: A systematic review and meta-analysis. DATA SOURCES: We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015. Only randomised controlled trials (RCTs) were included. OUTCOME MEASURE: We calculated clinical outcomes (all-cause mortality, bleeding-related mortality, upper gastrointestinal bleeding) as well as haemodynamic outcomes (hepatic venous pressure (HVPG) reduction, haemodynamic response rate, post-treatment arterial blood pressure (mean arterial pressure; MAP) and adverse events). RESULTS: 12 RCTs were included. In 7 trials that looked at haemodynamic outcomes compared carvedilol versus propranolol, showing that carvedilol was associated with a greater reduction (%) of HVPG within 6 months (mean difference -8.49, 95% CI -12.36 to -4.63) without a greater reduction in MAP than propranolol. In 3 trials investigating differences in clinical outcomes between carvedilol versus endoscopic variceal band ligation (EVL), no significant differences in mortality or variceal bleeding were demonstrated. 1 trial compared clinical outcomes between carvedilol versus nadolol plus isosorbide-5-mononitrate (ISMN), and showed that no significant difference in mortality or bleeding had been found. 1 trial comparing carvedilol versus nebivolol showed a greater reduction in HVPG after 14 days follow-up in the carvedilol group. CONCLUSIONS: Carvedilol may be more effective in decreasing HVPG than propranolol or nebivolol and it may be as effective as EVL or nadolol plus ISMN in preventing variceal bleeding. However, the overall quality of evidence is low. Further large-scale randomised studies are required before we can make firm conclusions. TRIAL REGISTRATION NUMBER: CRD42015020542.
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Li et al. (2016) conducted a meta-analysis in Cirrhosis and portal hypertension. Carvedilol vs. Propranolol, endoscopic variceal band ligation (EVL), nadolol plus isosorbide-5-mononitrate (ISMN), or nebivolol was evaluated on Hepatic venous pressure gradient (HVPG) reduction (%) within 6 months versus propranolol (Mean difference -8.49, 95% CI -12.36 to -4.63). Carvedilol was associated with a greater reduction in hepatic venous pressure gradient within 6 months compared to propranolol (mean difference -8.49; 95% CI -12.36 to -4.63).
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