New Delhi: A recent study showed a combination of intravenous L-ornithine L-aspartate (LOLA) with lactulose and rifaximin to be better than lactulose and rifaximin alone for treatment of cirrhosis patients with overt hepatic encephalopathy (OHE) grade III-IV. The combination of LOLA with lactulose and rifaximin improved grades of HE, recovery time from encephalopathy with lower mortality at 28 days.
Considering the limited data on the use of LOLA in the treatment of overt HE, Barjesh Chander Sharma, Department of Gastroenterology, GB Pant Hospital, New Delhi, India, and colleagues aimed to evaluate the role of intravenous LOLA in patients of cirrhosis with OHE grade III-IV in their study published in the journal Hepatology.
The double-blind randomized placebo-controlled trial included 140 patients. They were randomized to receive a combination of LOLA, lactulose, and rifaximin (n = 70) or placebo, lactulose, and rifaximin (n = 70). LOLA was given as continuous IV infusion at a dose of 30 g over 24 h for 5 days. The researchers measured ammonia levels, endotoxins, TNF-α, and ILs on days 0 and 5. The improvement in the grade of HE at day 5 was the primary outcome.
Salient findings of the study include:
Higher rates of improvement in grade of HE (92.5% vs. 66%), lower time to recovery (2.70 ± 0.46 vs. 3.00 ± 0.87 days), and lower 28-day mortality (16.4% vs. 41.8%) were seen in the LOLA group as compared with placebo.
Levels of inflammatory markers were reduced in both groups.
Significantly higher reductions in levels of blood ammonia, IL-6, and TNF-α were seen in the LOLA group.
"LOLA with lactulose and rifaximin combo is more effective than only lactulose and rifaximin in improving grades of HE, recovery time from encephalopathy, with lower 28-day mortality," the authors concluded.
Reference:
The study titled, "L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: A double-blind randomized controlled trial," was published in the journal Hepatology.
DOI: https://doi.org/10.1002/hep.32255