Retrospective non-inferiority study shows short-course octreotide achieves non-inferior rebleeding rates in acute variceal hemorrhage, suggesting shorter regimens safely cut costs.
Key Points
To determine whether short-course intravenous octreotide is non-inferior to long-course therapy in preventing early rebleeding and adverse clinical outcomes after acute variceal hemorrhage.
Multicenter, retrospective non-inferiority study across 13 hospitals within the Cleveland Clinic Health System from January 2020 to August 2024.
Evaluated 260 adults with cirrhosis and endoscopically confirmed acute variceal hemorrhage receiving post-endoscopic octreotide for either ≤72 hours (short-course, n=131) or >72 hours (long-course, n=129).
Assessed 5-day rebleeding as the primary endpoint against a prespecified 15% non-inferiority margin, alongside 48-hour rebleeding, transfusions, mortality, adverse events, and drug costs.
Rebleeding within 5 days occurred in 27.5% of short-course and 31.0% of long-course patients (absolute risk difference = -3.5%; 95% CI, -14.6% to 7.5%), establishing non-inferiority within the 15% margin.
Secondary outcomes were consistent across groups, including 48-hour rebleeding (17.6% vs 20.2%), median red blood cell transfusion (0 vs 0 units), and in-hospital mortality (10.7% vs 18.6%).
Adverse event rates for bradycardia, glycemic dysregulation, and ileus did not differ, whereas total octreotide-related costs were significantly lower in the short-course cohort.