Original Research
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Lactulose, with or without rifaximin, is typically recommended as treatment of choice for overt hepatic encephalopathy (HE) and secondary prevention. Emerging evidence evaluating polyethylene glycol (PEG) compared to lactulose for the treatment of acute HE denotes superior outcomes with PEG. However, the dosing, efficacy, safety, and tolerability of PEG in combination with lactulose for treatment and secondary prevention of HE is limited in the literature.
Research Question or Hypothesis: How does PEG used at doses commonly seen in practice affect the length of stay for patients with acute HE?
Study Design: Single center, retrospective.
Methods: Adult patients hospitalized with HE between August 1, 2018 and August 1, 2022 who received PEG, lactulose, and/or rifaximin were included. Two cohorts were analyzed: patients who received PEG vs. those who did not receive PEG for HE treatment. The primary outcome was length of hospitalization between groups. Secondary outcomes included HE recurrence, amount of study medications administered, and safety measures. The appropriate statistical tests were used for the type of data analyzed. A sensitivity analysis based on study medication administration was also conducted.
Results: A total of 440 patients were included, with 56 patients in the PEG group and 386 in the non-PEG group. PEG was associated with a longer median length of stay (16 vs. 6 days, p<0.0001), but this difference did not remain after sensitivity analysis (7 vs. 6 days, p=0.131). The PEG group received significantly less lactulose and rifaximin compared to the non-PEG group. Incidence of recurrence of HE and rehospitalization for any cause were not different between the two groups.
Conclusion: PEG was associated with a longer length of stay, but this was no longer seen after sensitivity analysis. Though PEG appears to be a safe option for this patient population, more prospective studies are needed to determine its efficacy and possible place in therapy.
Presenting Author
Haley N. Johnson PharmDWest Virginia University Medicine
Authors
William Call PharmD
Barnes-Jewish Hospital
Amanda Lonjers PharmD
Barnes-Jewish Hospital
Miranda Norvell PharmD
Barnes-Jewish Hospital
Patrick Finnegan PharmD
University of Health Sciences & Pharmacy in St. Louis
Amanda Tedder PharmD
Barnes-Jewish Hospital