Journal Scan / Research · July 28, 2021
Portal Pressure Effects of Metformin vs Placebo in Patients With Cirrhosis and Portal Hypertension
Alimentary Pharmacology & Therapeutics
TAKE-HOME MESSAGE
This is an interesting study in which the authors evaluated the administration of metformin immediately before measuring portal pressures in 32 patients with cirrhosis.
A 16% mean reduction in hepatic venous pressure gradient (HVPG) was seen in the metformin group compared with the placebo group. In patients with a baseline HVPG >12 mm Hg, clinically significant reductions were seen in 46% of the group. Further study is needed to clarify the role of metformin in portal hypertension.
– Natasha VonRoenn, MD
abstract
This abstract is available on the publisher's site.
BACKGROUND
Portal hypertension is the main determinant of clinical decompensation in patients with liver cirrhosis. In preclinical data metformin lowers portal pressure, but there are no clinical data for this beneficial effect.
AIMS
To investigate the acute effects of metformin on hepatic venous pressure gradient (HVPG) and liver perfusion.
METHODS
In a randomised, double-blinded study design, we investigated 32 patients with cirrhosis before and 90 minutes after ingestion of 1000-mg metformin (n = 16) or placebo (n = 16). Liver vein catherisation was performed to evaluate HVPG and indocyanine green (ICG) infusion for investigation of hepatic blood flow.
RESULTS
The mean relative change in HVPG was -16% (95% CI: -28% to -4%) in the metformin group compared with 4% (95% CI: -6% to 14%) in the placebo group (time × group interaction, P = 0.008). In patients with baseline HVPG ≥12 mm Hg clinically significant improvements in HVPG (HVPG <12 mm Hg or a >20% reduction in HVPG) were observed in 46% (6/13) of metformin-treated and in 8% (1/13) of placebo-treated patients (P = 0.07). There were no changes or differences in systemic blood pressure, heart rate, hepatic plasma and blood flow, hepatic ICG clearance, hepatic O2 uptake or inflammation markers between groups.
CONCLUSIONS
A single oral metformin dose acutely reduces HVPG in patients with portal hypertension without affecting systemic or liver hemodynamics or inflammatory biomarkers. This offers a promising perspective of a safe and inexpensive treatment option that should be investigated in larger-scale clinical studies with long-term outcomes in patients with cirrhosis and portal hypertension. 作者: StephenW 时间: 2021-9-22 18:13