Bradycardia and Other Arrhythmias in Patients With Hepatorenal Syndrome‐Acute Kidney Injury Following Terlipressin Treatment: A Pooled Analysis of Three North American Phase III Clinical Studies

ABSTRACT Background Terlipressin is the FDA‐approved systemic vasoconstrictor therapy for hepatorenal syndrome‐acute kidney injury (HRS‐AKI)—a rapidly progressive renal failure occurring in patients with decompensated cirrhosis and ascites. Bradycardia, a known effect of terlipressin, as well as other arrhythmias, has previously been reported in terlipressin‐treated patients. Aim To assess terlipressin‐related cardiac adverse events (AEs) in patients with HRS‐AKI. Methods Three North American‐centric Phase III, randomised, placebo‐controlled studies (OT‐0401, REVERSE, CONFIRM) were pooled in the largest‐to‐date prospective database. Cardiac AEs were reported by the investigators for each trial and retrospectively analysed. Results Bradycardia was the only cardiac AE reported more frequently in terlipressin‐treated patients compared with placebo (6.3% [22/349] vs. 0.8% [2/249]). In the terlipressin group, no bradycardia AEs were serious, 4.5% (1/22) of patients required a dose interruption, 9.1% (2/22) required a dose reduction, and none discontinued treatment due to bradycardia. The incidences of other arrhythmia AEs were similar in both treatment groups (terlipressin: 7.4% [26/349]; placebo 8.8% [22/249]). The incidence of atrial fibrillation serious AEs (SAEs) was low (terlipressin: 0.9% [3/349]; placebo: 1.6% [4/249]). There were no AE reports of torsades de pointes, while a QT interval prolongation was reported in two patients. Conclusions In a pooled analysis, bradycardia was observed in 6% of terlipressin‐treated patients but rarely required a dose interruption or reduction. Arrhythmia SAE incidences were low and similar in both treatment groups. Routine intensive cardiac monitoring for the detection of arrhythmias may not be necessary during terlipressin administration. Trial Registration OT‐0401: NCT00089570, REVERSE: NCT01143246 and CONFIRM: NCT02770716