Real-world Study Shows Better Adherence with Rifaximin for Hepatic Encephalopathy

Among patients with hepatic encephalopathy (HE) use of rifaximin and being adherent to the medication was associated with lower healthcare resource utilization (HCRU), according to a poster presented at AMCP 2021.

Based on these findings, Shiyu Zhang, MS, PhD candidate from The University of Texas at Austin, and colleagues wrote that clinicians may consider rifaximin monotherapy when patients have poor adherence.

This study was designed to compare baseline characteristics, adherence, and health care resource utilization (HCRU) among patients with HE in three groups: those on lactulose monotherapy, those on rifaximin monotherapy, and those on a combination of the two.

The researchers used a large nationwide claims database to look for patients with a diagnosis of HE who were continuously enrolled for 12 or more months and received one or both drugs mentioned from 2013 to 2015. Patients had to have sufficient laboratory data to calculate a Model for End-Stage Liver Disease (MELD) score.

In all, data form 610 patients with HE was included. More patients were prescribed lactulose than rifaximin or a combination (62.8% vs. 19.8% vs. 19.0%). Rifaximin or the combination was more common among patients younger than 65 than lactulose (62.8% vs. 60.3% vs. 48.0%). Lactulose was more commonly used than rifaximin and the combination among those 65 and older (52% vs. 37.2% vs 19.0%).

Patients that used rifaximin (P<0.001) and lactulose (P=0.047) were associated with significantly higher mean proportion of days covered. The rifaximin cohort was more likely to be adherent (odds ratio=5.7; 95% CI, 3.6-9.1). There was no significant difference in the total number of inpatient visits, emergency department visits, or length of stay among patients treated with the different regimens. A shorter length of stay was observed in patients who were adherent.

Zhang and colleagues suggested that future research should include more real-world evidence for assessment of rifaximin monotherapy effectiveness.

Zhang S, et al. Assessment of Adherence and Healthcare Utilization for Patients with Hepatic Encephalopathy (HE). Poster K6. Presented at AMCP 2021; April 12-16, 2021.