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Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: a pilot study (RIFA-AH)

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César Jiménez, Meritxell Ventura-Cots, Margarita Sala, Margalida Calafat, Montserrat Garcia-Retortillo, Isabel Cirera, Nuria Cañete, Germán Soriano, María Poca, Macarena Simón-Talero, José Altamirano, Michael Lucey, Guadalupe Garcia-Tsao, Robert S Brown, Robert F Schwabe, Elizabeth C Verna, Bernd Schnabl, Francisco Bosques-Padilla, Philippe Mathurin, Juan Caballería & 6 more Alexandre Louvet, Debbie L Shawcross, Juan G Abraldes, Joan Genescà, Ramon Bataller, Víctor Vargas

Original languageEnglish
Pages (from-to)1109-1120
Number of pages12
Issue number5
Early online date26 Feb 2022
E-pub ahead of print26 Feb 2022
PublishedMay 2022

Bibliographical note

Funding Information: Grant of “Instituto de Salud Carlos III” EC11‐0489. MV and MS are recipients of the Juan Rodés grant. BS is supported by the NIH center P30 DK120515. INTEAM Funding Source: U01AA021908, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA. Funding Information: The authors wish to acknowledge the late Dr. Juan Cordoba, who designed the study and also appreciate his outstanding professional work and research contribution in liver diseases. We would like to thank all the patients and study teams for their participation and contributions to this study. Finally, we thank all the members of the INTEAM consortium for providing the clinical data of the control group. Publisher Copyright: © 2022 The Authors. Liver International published by John Wiley & Sons Ltd.

King's Authors


Background & Aims: Alcoholic hepatitis (AH) is associated with a high incidence of infection and mortality. Rifaximin reduces bacterial overgrowth and translocation. We aimed to study whether the administration of rifaximin as an adjuvant treatment to corticosteroids decreases the number of bacterial infections at 90 days in patients with severe AH compared to a control cohort. Methods: This was a multicentre, open, comparative pilot study of the addition of rifaximin (1200 mg/day/90 days) to the standard treatment for severe AH. The results were compared with a carefully matched historical cohort of patients treated with standard therapy and matching by age and model of end-stage liver disease (MELD). We evaluated bacterial infections, liver-related complications, mortality and liver function tests after 90 days. Results: Twenty-one and 42 patients were included in the rifaximin and control groups respectively. No significant baseline differences were found between groups. The mean number of infections per patient was 0.29 and 0.62 in the rifaximin and control groups, respectively (p =.049), with a lower incidence of acute-on-chronic liver failure (ACLF) linked to infections within the treatment group. Liver-related complications were lower within the rifaximin group (0.43 vs. 1.26 complications/patient respectively) (p =.01). Mortality was lower in the treated versus the control groups (14.2% vs. 30.9, p =.15) without significant differences. No serious adverse events were associated with rifaximin treatment. Conclusions: Rifaximin is safe in severe AH with a significant reduction in clinical complications. A lower number of infections and a trend towards a lower ACLF and mortality favours its use in these patients.

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