Secondary prophylaxis of hepatic encephalopathy in cirrhosis of liver.


eMediNexus Editorial    17 July 2018

Hepatic encephalopathy (HE) is associated with a poor prognosis. Data related to the prevention of recurrence of encephalopathy with L-ornithine L-aspartate (LOLA) is scarce.

A new study published in the European Journal of Gastroenterology & Hepatology aimed to ascertain the efficacy of ornithine L-aspartate in the prevention of hepatic encephalopathy recurrence.

This was a double-blinded, randomized controlled trial at a tertiary center, wherein 150 consecutive patients with cirrhosis who had recovered from HE either received LOLA (6 g thrice daily) or an equivalent amount of placebo for 6 months. Here, patients were assessed by psychometric HE scores. Primary end point was development of overt HE.

The findings showed that HE recurred in 12.3% of the 73 patients receiving LOLA and in 27.7% of the 72 patients receiving placebo, respectively. Meanwhile, mortality was similar in both the groups. At the 6-month follow-up, there was a significant change in the psychometric hepatic encephalopathy score, ammonia level, critical flicker frequency, and sickness impact profile scores in patients treated with LOLA compared to those who were given placebo. On multivariate analysis, only Model for End-Stage Liver Disease (MELD) score predicted the recurrence of overt HE.

Hence, it was inferred that LOLA is effective in the secondary prophylaxis of HE and is associated with significant improvements in psychometric hepatic encephalopathy score, ammonia level, critical flicker frequency scores, and health-related quality of life.

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