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Tahara T, Mori K, Mochizuki M, Ishiyama R, Noda M, Hoshi H, Lefor AK, Shinozaki S. Tolvaptan is effective in treating patients with refractory ascites due to cirrhosis. Biomed Rep 2017; 7:558-562. [PMID: 29250327 PMCID: PMC5727763 DOI: 10.3892/br.2017.1005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022] Open
Abstract
The treatment of refractory ascites due to cirrhosis is a clinical challenge for hepatologists. Tolvaptan, a novel aquaporin modulator, was made available in Japan in 2013 for the treatment of patients with refractory ascites due to cirrhosis. Despite the potential of this drug, few reports are available regarding its clinical use. The aim of the present study was to clarify the efficacy of tolvaptan in patients with refractory ascites due to cirrhosis and to review the clinical outcomes of treatment. Medical records were retrospectively reviewed for 65 patients with refractory ascites due to cirrhosis who were treated daily with 7.5 mg tolvaptan. The median follow-up time, defined as the period between starting tolvaptan and the last clinic visit or date of mortality, was 175 days (interquartile range 56-406). After one week of tolvaptan treatment, the mean weight reduction was 3.4 kg, with a response rate of 69% (45/65). Subsequently, factors associated with the response to tolvaptan were analyzed. On univariate analysis, maintaining serum sodium (Na) ≥140 mEq/l and an estimated glomerular filtration rate (eGFR) ≥55 ml/min were significant predictors of response (P<0.05). On multivariate analysis, hepatitis C virus etiology, maintaining serum Na ≥140 mEq/l and an eGFR ≥55 ml/min were significant predictors of response (P<0.05). Factors associated with survival were also analyzed using the Cox proportional hazard model. On multivariate analysis, responsiveness to tolvaptan was a predictor of long-term survival (P=0.002), and hyperbilirubinemia was associated with short-term survival (P=0.028). Additionally, Kaplan-Meier analysis with a log-rank test indicated longer survival times in tolvaptan responders than non-responders (P=0.011). In conclusion, tolvaptan was effective in treating patients with refractory ascites due to cirrhosis. In particular, tolvaptan treatment was highly effective for patients with hepatitis C virus etiology and normal serum Na and renal function. Furthermore, response to tolvaptan was associated with longer survival time while hyperbilirubinemia was associated with shorter survival time.
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Affiliation(s)
- Toshiyuki Tahara
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Kiyoto Mori
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Mari Mochizuki
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Ryoko Ishiyama
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Marin Noda
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Hitomi Hoshi
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi 329-0974, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
| | - Satoshi Shinozaki
- Shinozaki Medical Clinic, Utsunomiya, Tochigi 321-3223, Japan
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
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