Continuous terlipressin infusion reduces treatment failure and rebleeding in acute variceal bleeding

BACKGROUND & AIMS: Terlipressin is crucial for treating acute oesophageal variceal bleeding (AEVB) and hepatorenal syndrome (HRS). This meta-analysis compared the continuous versus bolus terlipressin infusion for treating the above conditions in patients with cirrhosis. METHODS: Three major databases were searched for randomised controlled trials (RCTs) comparing two infusion strategies. A meta-analysis was conducted to estimate the risk ratios (RR) with a 95% confidence interval (CI) based on a random-effects model. Subgroup analyses were performed to account for adverse events (AEs) in terms of severity and organ systems. Additionally, a dose-response analysis was conducted to evaluate the correlation between drug dosage and AEs. RESULT: Six RCTs (494 patients) were included. Compared with bolus infusion, continuous terlipressin infusion showed less treatment failure (RR, 0.32; 95% CI, 0.12-0.87; p = 0.03), less rebleeding (RR, 0.52; 95% CI, 0.33-0.81; p < 0.01) and a trend toward lower mortality (RR, 0.62; 95% CI, 0.30-1.28; p = 0.19) in patients with AEVB, while response rates were comparable in patients with HRS (RR, 1.11; 95% CI, 0.87-1.41; p = 0.40) and a risk reduction of total AEs (RR, 0.59; 95% CI, 0.45-0.76; p < 0.01). Subgroup analyses stratifying AEs supported these findings, and a correlation was noted between drug dose and cardiovascular AEs. CONCLUSION: Compared to bolus administration, continuous terlipressin infusion reduces treatment failure and rebleeding rates in patients with AEVB; provides a comparable response rate in patients with HRS; and decreases the incidence of total, severe, and cardiovascular AEs while allowing for lower overall doses.