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Satavaptan for the management of ascites in cirrhosis: efficacy and safety across the spectrum of ascites severity
  1. Florence Wong1,
  2. Hugh Watson2,
  3. Alexander Gerbes3,
  4. Hendrik Vilstrup4,
  5. Salvatore Badalamenti5,
  6. Mauro Bernardi6,
  7. Pere Ginès7,
  8. for the Satavaptan Investigators Group
  1. 1Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Sanofi Aventis R&D, Paris, France
  3. 3Liver Center Munich, Department of Medicine 2, Klinikum of the LMU-Grosshadern, University of Munich, Munich, Germany
  4. 4Department of Medicine V (Hepatology and Gastroenterology), Aarhus University Hospital, Aarhus, Denmark
  5. 5Sanofi Aventis R&D, Bridgewater, New Jersey, USA
  6. 6Dipartimento di Medicina Clinica, Alma Mater Studiorum, Semeiotica Medica, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
  7. 7Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi-Sunyer), CIBEReHD (Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas), Barcelona, Catalunya, Spain
  1. Correspondence to Dr Pere Ginès, Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; pgines{at}clinic.ub.es

Abstract

Objective Satavaptan, a vasopressin V2 receptor antagonist, has been shown to improve the control of ascites in cirrhosis in short-term phase II studies. The aim of this study was to evaluate the efficacy and safety of satavaptan in three different populations of patients with cirrhosis and ascites.

Methods 1200 patients were included in three randomised double-blind studies comparing satavaptan with placebo in uncomplicated ascites (study 1: n=463 patients) and difficult-to-treat ascites, with and without concomitant diuretic treatment (studies 2 and 3: n=497 and n=240 patients, respectively).

Results Satavaptan was not more effective than placebo in the control of ascites in any of the populations studied as estimated by the primary efficacy endpoints: worsening of ascites (study 1) and the cumulative number of large-volume paracenteses during 12 weeks (studies 2 and 3). Nevertheless, some of the secondary efficacy endpoints related to the treatment of ascites were met in the three studies, suggesting a slight advantage of satavaptan over placebo in delaying ascites formation. Moreover, satavaptan was more effective than placebo in improving the serum sodium concentration in patients with hyponatraemia. The incidence of major complications of cirrhosis during follow-up did not differ significantly between the satavaptan and placebo groups in the three studies. Overall, the rate of any treatment-related adverse events, serious treatment-related events and treatment-related events leading to permanent discontinuation of treatment did not differ significantly between the treatment groups. However, in study 2 mortality was higher in patients treated with satavaptan compared with placebo (HR 1.47; 95% CI 1.01 to 2.15); no significant differences in mortality between the two groups were observed in the other two studies. No specific cause for the increased mortality was identified. Most deaths were associated with known complications of liver cirrhosis.

Conclusion Satavaptan, alone or in combination with diuretics, is not clinically beneficial in the long-term management of ascites in cirrhosis.

  • Ascites
  • fluid retention in liver disease
  • liver
  • liver cirrhosis
  • hepatorenal syndrome
  • hepatic haemodynamics
  • portal hypertension
  • cardiovascular complications
  • cirrhosis
  • haemodynamics in cirrhosis
  • hepatocellular carcinoma
  • bacterial infection

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Footnotes

  • Funding Supported by Sanofi Aventis.

  • Competing interests This study was funded in part by Sanofi Aventis. FW and PG have acted on a consultancy basis for Sanofi Aventis. HW and SB are employees of Sanofi Aventis.

  • Ethics approval Ethics approval was provided by the ethics committees of the various hospitals involved.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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