Taurine a feasible alternative for treating portal hypertension in cirrhotic patients
The amino sulphonic acid taurine may safely and effectively reduce portal pressure in cirrhotic patients, a study has shown.
In the study, 22 patients (mean age 52 years; 64 percent male) with hepatic venous pressure gradient (HVPG) ≥12 mm Hg were randomized to treatment with oral taurine (6 g/day; n=12) or placebo (n=10) for 4 weeks. None of the patients received concomitant nonselective beta-blocker therapy. Response to treatment was evaluated by measuring HVPG at day 28.
At baseline, 9 percent of patients had Child-Pugh class A, 64 percent had class B and 27 percent had class C. Ascites were observed in 68 percent.
After 28 days of treatment, mean HVPG dropped by 12 percent from baseline (from 20 to 18 mm Hg; p=0.0093) in the taurine group and increased by 2 percent (from 20 to 21 mm Hg; p=0.4945) in the placebo group. HVPG response >10 percent was achieved by 58 percent of taurine-treated patients vs 0 percent of placebo-treated patients (p=0.0053). Neither taurine nor placebo affected systemic haemodynamics.
In a multivariate linear model, taurine was superior to placebo in reducing HVPG (p=0.0091 for absolute change; p=0.0109 for relative change).
In terms of safety, gastrointestinal discomfort and fatigue were the most commonly reported treatment-related adverse events. Such events were usually mild and comparable between the taurine and placebo groups, and none resulted in treatment discontinuation.
The present data confirm that the 6 g dosing of taurine is well-tolerated in patients with cirrhosis, researchers said. Additional dose-ranging studies are warranted to investigate whether higher taurine doses increase efficacy, or if doses of <6 g taurine per day are sufficient to achieve similar response rates.
To date, nonselective beta-blockers are the only recommended medical treatment for portal hypertension, with a meta-analysis showing that carvedilol is more effective than propranolol. However, response rates with carvedilol are only about 50 to 60 percent. About 15 percent of patients may have contraindications, and an additional 15 percent may not tolerate nonselective beta-blockers. [Aliment Pharmacol Ther 2014;39:557.68; Gastroenterology 2009;136:1651-1658]