CARVEDILOL IS ASSOCIATED WITH LOWER MORTALITY THAN OTHER NON- SELECTIVE BETA BLOCKERS IN PATIENTS WITH CIRRHOSIS

Carvedilol Found to Reduce Mortality and Hepatic Decompensation in Cirrhosis Patients

A recent study has highlighted the advantages of carvedilol over other nonselective beta blockers (NSBBs) such as propranolol and nadolol in patients with cirrhosis. This research builds on existing recommendations from the American Association for the Study of Liver Disease (AASLD), which advocates for carvedilol as the preferred NSBB in cirrhosis with portal hypertension due to its additional anti-α-1-adrenergic activity. The study offers compelling evidence of carvedilol’s superiority in reducing hepatic decompensation and overall mortality, reinforcing its role as a key therapy in managing cirrhosis.

Examining Broader Outcomes

While prior studies have demonstrated carvedilol’s effectiveness in reducing hepatic venous pressure gradient (HVPG) and preventing variceal bleeding, they often relied on surrogate markers or limited clinical endpoints. In contrast, this retrospective case-control study evaluated broader real-world outcomes including hepatic decompensation (ascites, hepatic encephalopathy, and variceal bleeding) and all-cause mortality, providing a more comprehensive view of carvedilol's benefits.

Study Design and Key Findings

Researchers analysed data from 2,302 patients with cirrhosis identified through ICD-10 coding and platelet counts below 150. Among these, 1,629 patients (70.8%) were prescribed carvedilol, while 673 (29.2%) received either propranolol or nadolol. Time- dependent Cox regression was used to adjust for confounding factors.

The findings were significant:

• Reduced Hepatic Decompensation: Carvedilol users had a markedly lower risk of decompensation events (p<0.001) compared to those on propranolol or nadolol. This reduction was consistent across all types of decompensations including ascites, hepatic encephalopathy and variceal bleeding.
• Lower Mortality Risk: Patients on carvedilol exhibited a moderately lower risk of all- cause mortality (p=0.031).
• SOFA Score: Indicating improved overall organ function

These results were consistent across various sensitivity analyses, confirming the robustness of the findings.

Implications for Clinical Practice

The trial's findings were notable, showing a 30% lower mortality rate in the early CRRT group compared to the delayed group. Specifically, 46.2% of early CRRT patients died, compared to 75% in the delayed group (per-protocol analysis). While the intention-to-treat analysis showed no significant difference, the per-protocol results strongly highlighted the benefits of timely CRRT.

The results underscore the superiority of carvedilol in reducing both hepatic decompensation and mortality in cirrhosis patients, supporting its use as the preferred NSBB in this population. Patients on carvedilol not only experienced fewer complications such as ascites and encephalopathy but also demonstrated improved survival outcomes.

As evidence mounts, carvedilol appears to offer a more comprehensive therapeutic approach for managing cirrhosis with portal hypertension. The researchers recommend further investigation to refine treatment strategies and confirm these findings in prospective studies, but the data strongly suggest that carvedilol is a critical component in improving outcomes for cirrhosis patients.

Table 1. Cox-model (time-dependent)