Kulkarni Anand V, Arab Juan Pablo, Premkumar Madhumita, Benítez Carlos, Tirumalige Ravikumar Sowmya, Kumar Pramod, Sharma Mithun, Reddy Duvvuru Nageshwar, Simonetto Douglas A, Rao Padaki Nagaraja
Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Liver Int. 2020 Dec;40(12):2888-2905. doi: 10.1111/liv.14703.
Vasoactive drugs form the mainstay of therapy for two of the most important complications of liver disease: hepatorenal syndrome (HRS) and acute variceal bleed (AVB). With cumulative evidence supporting the use in cirrhosis, terlipressin has been recommended for the management of HRS and AVB. However, owing to the safety concerns, terlipressin was not approved by food and drug administration (FDA) until now. In this review, we discuss the pharmacology and the major practice-changing studies on the safety and efficacy of terlipressin in patients with cirrhosis particularly focusing on existing indications like AVB and HRS and reviewing new data on the expanding indications in liver disease. The references for this review were identified from PUBMED with MeSH terms such as "terlipressin," "hepatorenal syndrome," "varices, esophagal and gastric," "ascites" and "cirrhosis." Terlipressin, a synthetic analogue of vasopressin, was introduced in 1975 to overcome the adverse effects of vasopressin. Terlipressin is an effective drug for HRS reversal in patients with liver cirrhosis and acute-on-chronic liver failure. There is documented mortality benefit with terlipressin therapy in HRS and AVB. Adverse effects are common with terlipressin and need to be monitored strictly. There is some evidence to support the use of this drug in refractory ascites, hepatic hydrothorax, paracentesis-induced circulatory dysfunction and perioperatively during liver transplantation. However, terlipressin is not yet recommended for such indications. In conclusion, terlipressin has stood the test of time with expanding indications and clear prerequisites for clinical use. Our review warrants a fresh perspective on the efficacy and safety of terlipressin.
肝肾综合征（HRS）和急性静脉曲张出血（AVB）。随着越来越多的证据支持在肝硬化中使用，特利加压素已被推荐用于治疗HRS和AVB。然而，由于安全问题，特利加压素至今尚未获得美国食品药品监督管理局（FDA）的批准。在本综述中，我们讨论了特利加压素在肝硬化患者中的药理学以及关于其安全性和有效性的主要改变实践的研究，特别关注诸如AVB和HRS等现有适应症，并回顾了肝病中不断扩大的适应症的新数据。本综述的参考文献通过PUBMED以“特利加压素”、“肝肾综合征”、“食管和胃静脉曲张”、“腹水”和“肝硬化”等医学主题词进行检索。特利加压素是一种血管加压素的合成类似物，于1975年被引入以克服血管加压素的不良反应。特利加压素是逆转肝硬化和慢加急性肝衰竭患者HRS的有效药物。有文献记载特利加压素治疗HRS和AVB可降低死亡率。特利加压素的不良反应很常见，需要严格监测。有一些证据支持在难治性腹水、肝性胸水、腹腔穿刺术引起的循环功能障碍以及肝移植围手术期使用该药。然而，特利加压素尚未被推荐用于这些适应症。总之，特利加压素经受住了时间的考验，适应症不断扩大，临床使用的前提条件明确。我们的综述为重新审视特利加压素的疗效和安全性提供了新的视角。
