Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis

Carvedilol NSBB with potential to ameliorate hepatic vascular resistance * Improve CSPH * Unclear if can prevent decompensation AIM assess whether carvedilol may prevent decompensation and improve survival in compensated cirrhosis with CSPH Carvedilol to improve risk of decompensation and survival in compensated cirrhosis Competing-risk meta-analysis of individual patient data Background / AIM POOLED Carvedilol significantly decrease the risk of developing decompensation (competing events: death & liver transplant) POOLED Carvedilol significantly improve survival (liver transplant, competing event) Systematic review to identify RCTs comparing carvedilol vs control therapy Only compensated patients included To optimize statistical assessment we performed individual patient data meta-analysis using time-to-event with competing-risk regression models adjusted by IPTW 4 RCTs included 352 patients with compensated cirrhosis * 181 treated with carvedilol vs * 171 controls (79 received EVL and 92 placebo) Methods screening patients with compensated cirrhosis for CSPH to start carvedilol can prevent the progression of compensated cirrhosis to decompensation, improving survival and reducing health-care burden and cost Results CONCLUSIONS Good Prognosis COMPENSATED CIRRHOSIS High mortality