Terlipressin versus norepinephrine in the treatment of type 1 hepatorenal syndrome: a review

Abstract

Hepatorenal syndrome (HRS) is a potentially reversible clinical syndrome in which a functional renal failure occurs in end-stage liver disease cases. It is a fatal complication of advanced cirrhosis with ascites and liver failure, with nearly 50% of the patients dying within 2 weeks after the onset. While terlipressin is expensive and not widely available, it is recognized as an effective treatment for HRS. Noradrenaline could be an efficient substitute. This is a systematic review that was carried out, including PubMed, Google Scholar, and EBSCO databases, which examined randomized trials of norepinephrine and terlipressin in the treatment of HRS to summarize the major RCTs that compare terlipressin versus norepinephrine in the treatment of type 1 HRS (HRS-). This review included six randomized studies that compared norepinephrine and terlipressin in the treatment of HRS-1. The findings show that two treatments had the same HRS reversal rate and the difference in efficacy in treating HRS-1. This review concludes that there is no difference in the efficacy of norepinephrine and terlipressin in the treatment of HRS-1. Norepinephrine is found to be effective and as safe as terlipressin. It is less expensive, widely available in many countries, and could be used as an alternative to terlipressin in the management of HRS-1.