Hepatic encephalopathy (HE) carries a poor prognosis. Yet no studies have investigated the role of L-ornithine L-aspartate (LOLA) in preventing encephalopathy recurrence.

A recent double-blind, randomized controlled trial enrolled the patients with cirrhosis who had recovered from HE and randomized them to receive LOLA (6 g thrice daily) or a similar amount of placebo for 6 months. It assessed the patients by psychometric HE scores using five paper-pencil tests, critical flicker frequency test, arterial ammonia, and sickness impact profile scores at inclusion. The study looked for the development of overt HE.

The findings were as follows-

• The study enrolled 150 patients.
• HE recurred in 12.3% and 27.7% of patients receiving LOLA and placebo, respectively, with a hazard ratio of 0.389.
• Both groups showed similar mortality (6.8 vs. 13.8%).
• At six months of follow-up, patients treated with LOLA showed a significant change in the psychometric hepatic encephalopathy score, ammonia level, CFF, and SIP scores than the placebo.
• Multivariate analysis showed only a MELD score predicts the recurrence of overt HE, with an odds ratio of 2.21.

This study confirms the effectiveness of LOLA in the secondary prophylaxis of HE. Further, its use is associated with significant improvements in psychometric hepatic encephalopathy score, ammonia level, critical flicker frequency scores, and health-related quality of life.

Source: Varakanahalli S, Sharma BC, Srivastava S, et al. Eur J Gastroenterol Hepatol. 2018 Aug;30(8):951-958. doi: 10.1097/MEG.0000000000001137.