Rifaximin Lowers Hepatic Encephalopathy Risk in Cirrhosis

Medscape

29-05-2025

Rifaximin significantly reduces the risk for hepatic encephalopathy (HE) in patients with cirrhosis, with greater effectiveness observed with longer treatment durations. METHODOLOGY: Rifaximin is recommended as an add-on therapy to lactulose for preventing the recurrence of HE, with its efficacy noted in a prior meta-analysis; however, few studies have examined its use for HE prevention.
Researchers performed a systematic review and meta-analysis of randomized controlled trials involving patients with cirrhosis aged 18 years or older.
Patients received either rifaximin or nonrifaximin interventions, such as nonabsorbable disaccharides, other antibiotics, L-ornithine-L-aspartate, or placebo.
Primary outcomes included the incidence of HE, all-cause mortality, and adverse events. TAKEAWAY: Researchers included 12 randomized controlled trials involving 1939 patients.
Compared with nonrifaximin interventions and placebo, rifaximin significantly reduced HE incidence (relative risk [RR], 0.58; P = .000), as analyzed from 10 studies. Rifaximin was significantly more effective than placebo (RR, 0.57; P = .000), but its effects were noncomparable to those of nonabsorbable disaccharides.
= .000), as analyzed from 10 studies. Rifaximin was significantly more effective than placebo (RR, 0.57; = .000), but its effects were noncomparable to those of nonabsorbable disaccharides. Rifaximin treatment durations longer than 1 month were more effective in reducing HE risk (RR, 0.55; P = .000).
= .000). In patients with prior HE episodes, rifaximin reduced recurrence risk by 51% compared with other interventions and placebo (five trials).
Among patients receiving transjugular intrahepatic portosystemic stent shunt (TIPSS), rifaximin reduced HE risk by 30% compared with placebo ( P = .027; two trials).
= .027; two trials). No significant differences were observed in all-cause mortality or adverse events between the groups, based on analyses of nine and six trials, respectively. IN PRACTICE:
'RFX [rifaximin] therapy is effective and well-tolerated in preventing HE and can be used as the first choice in the prophylaxis of HE after TIPSS,' the authors wrote. SOURCE:
This study was led by Yangyang Hu, Hebei Medical University Third Hospital, Shijiazhuang, China, and published online in PLOS One . LIMITATIONS:
The analysis excluded unpublished literature, potentially introducing publication and reporting bias. Only randomized controlled trials were included, and six lacked blinding, which could have affected the stability of the results. Variability in rifaximin interventions (eg, drug dosage and treatment duration) may have also affected the findings. DISCLOSURES:
This study was supported by the Natural Science Foundation of Hebei Province of China. The authors declared no competing interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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Cite this: Edited by Manasi Talwadekar. Rifaximin Lowers Hepatic Encephalopathy Risk in Cirrhosis - Medscape - May 29, 2025.