β-blockers may halt cirrhosis progression: PREDESCI trial

In patients with compensated cirrhosis and portal hypertension, β-blocker use reduced decompensation risk but not mortality.

Prof. Candid Villaneuva (Hospital Creu Sant Pau, Barcelona, Spain) presented the PREDESCI trial, a randomised, double-blind, placebo-controlled trial which aimed to determine whether reducing portal pressure with β-blockers lowers decompensation and death rates in 201 patients (of the 631 patients evaluated) with compensated cirrhosis and clinically significant portal hypertension (CSPH) defined by a hepatic venous pressure gradient ≥10 mmHg) without high-risk varices.

Participants were split into 2 groups based on their response to β-blockers: a β-blocker–responsive group, defined as ≥10% drop in hepatic venous pressure gradient from baseline when given a propranolol infusion challenge (n=135) or a β-blocker–nonresponsive group (n=66). The responsive group was then randomised to receive either propranolol or placebo and the nonresponsive group to either carvedilol or placebo. The primary endpoint was incidence of decompensation or death.

During a median follow-up of 37 months, among the 100 patients who received β-blockers, the rate of decompensation or death was significantly lower compared with the 101 patients who received placebo (16% vs 27%; HR 0.51; 95% CI 0.26-0.97; P=0.04). This difference was attributable to a significantly lower incidence of ascites (HR 0.44; 95% CI 0.20–0.97; P=0.03). Rates of encephalopathy, haemorrhage, and mortality were similar between groups.

In conclusion, this study suggests that in patients with compensated cirrhosis and CSPH, long-term treatment with non-selective β-blockers halves the risk of decompensation or death. Importantly, these results suggest that patients with compensated cirrhosis should be screened for CSPH, and started on a non-selective β-blocker if it is present.

1. Villanueva C et al. UEG Week 2019, Abstract IP235.

Posted on 23 October 201918 March 2021