PMID- 29067149 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220409 IS - 2041-4137 (Print) IS - 2041-4145 (Electronic) IS - 2041-4137 (Linking) VI - 8 IP - 4 DP - 2017 Oct TI - The impact of rifaximin-alpha on the hospital resource use associated with the management of patients with hepatic encephalopathy: a retrospective observational study (IMPRESS). PG - 243-251 LID - 10.1136/flgastro-2016-100792 [doi] AB - OBJECTIVE: To compare all-cause and liver-related hospital resource use in the 6 and 12 months pre-rifaximin-alpha and post-rifaximin-alpha initiation in UK patients with hepatic encephalopathy (HE). DESIGN: A UK multicentre, retrospective, observational study. Patients' medical records were reviewed for demographics, clinical outcomes and adverse events (AEs) to rifaximin-alpha. Details of hospital admissions/attendances in the 6 and 12 months pre-rifaximin-alpha and post-rifaximin-alpha initiation were extracted from hospital electronic databases. SETTING: 13 National Health Service centres. PATIENTS: 207 patients with HE who initiated rifaximin-alpha between July 2008 and May 2014. Hospital resource use data were available for 145/207 patients. MAIN OUTCOME MEASURE: Change in mean number of liver-related hospital bed days/patient (total and critical care) between the 6 months pre-rifaximin-alpha and post-rifaximin-alpha initiation. RESULTS: Comparing the 6 months pre-rifaximin-alpha and post-rifaximin-alpha initiation in alive patients at the end of the observation period (N=114): there were significant reductions in the mean number of hospitalisations/patient (liver-related 1.3 to 0.5, p<0.001; all-cause 1.9 to 0.9, p<0.001), hospital bed days/patient (liver-related 17.8 to 6.8, p<0.001; all-cause 25.4 to 10.6, p<0.001), 30-day hospital readmissions/patient (liver-related 0.5 to 0.2, p=0.039; all-cause 0.8 to 0.4, p=0.024) and emergency department (ED) attendances/patient (all-cause, 1.0 to 0.5, p<0.001). The mean critical care bed days/patient reduced significantly for all-cause admissions (1.3 to 0.3, p=0.049); non-significant reduction for liver-related admissions. 4% of patients (9/207) developed AEs. CONCLUSIONS: In UK clinical practice, treatment with rifaximin-alpha for HE is well-tolerated and associated with significant reductions in hospitalisations, bed days (including critical care), ED attendances and 30-day readmissions. FAU - Hudson, Mark AU - Hudson M AD - Liver Unit, Freeman Hospital, Newcastle upon Tyne, UK. FAU - Radwan, Amr AU - Radwan A AD - UK Medical Affairs, Norgine, Harefield, UK. FAU - Di Maggio, Paola AU - Di Maggio P AD - UK Medical Affairs, Norgine, Harefield, UK. FAU - Cipelli, Riccardo AU - Cipelli R AD - pH Associates, Marlow, UK. FAU - Ryder, Stephen D AU - Ryder SD AD - NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, UK. FAU - Dillon, John F AU - Dillon JF AD - Department of Gastroenterology, Ninewells Hospital and The School of Medicine, University of Dundee, Dundee, UK. FAU - Cash, William Jonathan AU - Cash WJ AD - The Liver Unit, Royal Victoria Hospital, Belfast, UK. FAU - Przemioslo, Robert T AU - Przemioslo RT AD - Department of Gastroenterology, Southmead Hospital, Bristol, UK. FAU - Wright, Mark AU - Wright M AD - Department of Hepatology, University Hospital Southampton, Southampton, UK. FAU - Shawcross, Debbie L AU - Shawcross DL AD - Institute of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital, London, UK. FAU - Jalan, Rajiv AU - Jalan R AD - Liver Failure Group, University College London Institute for Liver and Digestive Health, Royal Free Hospital, London, UK. FAU - Saksena, Sushma AU - Saksena S AD - Department of Gastroenterology, University Hospital of North Durham, Durham, UK. FAU - Allison, Michael AU - Allison M AD - Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK. FAU - Richardson, Paul AU - Richardson P AD - Department of Gastroenterology and Hepatology, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Liverpool, UK. FAU - Farrington, Elizabeth AU - Farrington E AD - Department of Gastroenterology & Hepatology, Royal Cornwall Hospital, Cornwall, UK. FAU - Aspinall, Richard J AU - Aspinall RJ AD - Department of Gastroenterology & Hepatology, Queen Alexandra Hospital, Portsmouth, UK. LA - eng PT - Journal Article DEP - 20170407 PL - England TA - Frontline Gastroenterol JT - Frontline gastroenterology JID - 101528589 CIN - Frontline Gastroenterol. 2017 Oct;8(4):230-231. PMID: 29082939 PMC - PMC5641856 OTO - NOTNLM OT - ANTIBIOTIC THERAPY OT - HEALTH ECONOMICS OT - HEPATIC ENCEPHALOPATHY OT - LIVER CIRRHOSIS COIS- Competing interests: AR was an employee of Norgine at the time this work was undertaken. PDM is an employee of Norgine. RC is an employee of pH Associates, which was commissioned by Norgine to provide support with the design and conduct of the study, data analysis and medical writing. JFD has received honoraria for lectures from Norgine. DS and MH have served as a speaker, consultant and an advisory board member for Norgine. RJ: Inventor (Ornithine phenyl acetate for the treatment of hepatic encephalopathy (licensed to Ocera Therapeutics)); Consultancy and Speaker Fees (Ocera Therapeutics, Norgine); Research Collaboration (Ocera Therapeutics, Takeda); Chief Investigator (Sequana medical sponsored study of alfapump); Founder (UCL spin-out company, Yaqrit (Yaq-001, TLR4 antagonist, DIALIVE: Albumin exchange and Endotoxin removal)). MA and RJA have attended UK Advisory Boards for Norgine. EF has served as consultant and speaker for Norgine. SS has received travel support from Norgine, AbbVie, Merck and Roche and attended, in advisor capacity, two meetings hosted by Norgine related to research in HE. SDR, WJC, RTP, MW and PR have no competing interests. EDAT- 2017/10/27 06:00 MHDA- 2017/10/27 06:01 PMCR- 2018/10/01 CRDT- 2017/10/26 06:00 PHST- 2016/12/09 00:00 [received] PHST- 2017/03/06 00:00 [revised] PHST- 2017/03/17 00:00 [accepted] PHST- 2017/10/26 06:00 [entrez] PHST- 2017/10/27 06:00 [pubmed] PHST- 2017/10/27 06:01 [medline] PHST- 2018/10/01 00:00 [pmc-release] AID - flgastro-2016-100792 [pii] AID - 10.1136/flgastro-2016-100792 [doi] PST - ppublish SO - Frontline Gastroenterol. 2017 Oct;8(4):243-251. doi: 10.1136/flgastro-2016-100792. Epub 2017 Apr 7.