To the Editor: Mumtaz and Ford (1) raise some questions about our study and challenge the validity of the conclusion. The aim of our study (2) was to answer a simple question: do branched-chain amino acids (BCAAs) benefit cirrhotic patients who are discharged after an episode of hepatic encephalopathy (HE)? The study had a pragmatic design, with broad eligibility criteria and prolonged follow-up, to improve the applicability of the results. The sample-size calculation was based on the information that was available at that time (3). This population shows a high recurrence of HE (50% at 1 year), but also a high mortality (50% at 1 year). Thus, while estimating the sample size we already expected that a high number of patients who would develop HE were not going to reach week 56. Owing to the high number of patients who did not reach week 56, the main end point was the actuarial probability of remaining free of recurrence. This approach takes into the consideration the duration of treatment, which is important in determining the outcome. The results were analyzed as intention-to-treat; the calculations included all patients randomized and followed until being censored. The results are very similar if analyzed in terms of the proportion of patients with recurrence of HE: 24 patients in the BCAA group (41%, 95% confidence interval (CI) 30–54%) and 32 patients in the maltodextrin group (55%, 95% CI 42–57%), a difference (14%) that was not statistically significant (P=0.14). There were patients in whom HE recurred and so they did not reach week 56, mostly due to liver transplant or death, which explains the apparent divergences between recurrence and not having finished the follow-up. The magnitudes of the difference in secondary end points (neuropsychology and anthropometry), which were on favor for BCAA, were mild and without impact on quality of life. This reinforces the interpretation that the difference in outcome is of no major clinical relevance.