Worland T, Hey P, Wong D, Apostolov R, Chan RK, Sinclair M, Gow P. Rifaximin-α use is associated with improved muscle mass in patients with cirrhosis. World J Hepatol 2025; 17(4): 104056 [DOI: 10.4254/wjh.v17.i4.104056]
Corresponding Author of This Article
Thomas Worland, MD, Department of Gastroenterology, Monash Health, Clayton Road, Clayton 3168, Victoria, Australia. thomas.worland@monashhealth.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2025; 17(4): 104056 Published online Apr 27, 2025. doi: 10.4254/wjh.v17.i4.104056
Rifaximin-α use is associated with improved muscle mass in patients with cirrhosis
Thomas Worland, Penelope Hey, Darren Wong, Ross Apostolov, Roseanne Kimberley Chan, Marie Sinclair, Paul Gow
Thomas Worland, Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia
Penelope Hey, Ross Apostolov, Roseanne Kimberley Chan, Marie Sinclair, Paul Gow, Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
Penelope Hey, Darren Wong, Ross Apostolov, Marie Sinclair, Paul Gow, Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia
Darren Wong, Department of Gastroenterology, Austin Health, Heidelberg 3084, Victoria, Australia
Author contributions: Study design and protocol development were done by Hey P and Gow P; ethics approval was obtained Hey P and Gow P; data collection was done by Worland T, Apostolov R, and Chan RK; data interpretation and analysis were undertaken by Worland T, Wong D, Sinclair S, and Gow P; all authors contributed to the manuscript preparation and revision and have approved the final version.
Institutional review board statement: This research project was approved by the local office of research and ethics, Audit/20/Austin/121.
Informed consent statement: The need for patient consent was waived due to the retrospective and deidentified nature of this study.
Conflict-of-interest statement: No other relevant conflict-of-interests exist in relation to this study for all authors.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thomas Worland, MD, Department of Gastroenterology, Monash Health, Clayton Road, Clayton 3168, Victoria, Australia. thomas.worland@monashhealth.org
Received: December 9, 2024 Revised: February 21, 2025 Accepted: April 3, 2025 Published online: April 27, 2025 Processing time: 137 Days and 22.2 Hours
Abstract
BACKGROUND
Sarcopaenia is associated with a two-fold higher mortality rate in patients with cirrhosis independent of liver disease severity. Few treatments for cirrhosis related sarcopaenia exist beyond optimal nutritional management.
AIM
To assess if rifaximin-α, a minimally absorbed antimicrobial used to manage hepatic encephalopathy (HE), may improve sarcopaenia in cirrhosis through its ammonia lowering and anti-inflammatory properties.
METHODS
This single-centre retrospective cohort study of patients with prior HE compared patients treated with lactulose alone to those on combination therapy with rifaximin-α. The primary outcome was a change in skeletal muscle area (SMA) as measured by computed tomography over two time points. Secondary outcomes included episodes of spontaneous bacterial peritonitis, variceal bleeding, and gastrointestinal Clostridium difficile infection.
RESULTS
Of the 142 patients included, 63 were on rifaximin-α [35% female, median age 57 (51, 62)], and 79 were on lactulose without rifaximin-α [20% female, median age 55 (51, 60)]. Univariate analysis for SMA found that male sex (P < 0.001), hepatocellular carcinoma presence (P = 0.024), and greater baseline body mass index (P = 0.001) were associated with improvement of SMA. Multivariate analysis that adjusted for baseline SMA was performed and found only use of rifaximin-α (P = 0.029) to be associated with improvement of SMA.
CONCLUSION
This study demonstrates a significant independent association between rifaximin-α therapy and muscle mass in patients with cirrhosis and HE. Prospective studies of rifaximin-α therapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort.
Core Tip: Sarcopaenia is associated with poorer outcomes in cirrhotic patients. In our study Rifaximin use was found to be independently associated with improvement of muscle mass in patients with cirrhosis. Rifaximin's potential as a therapeutic agent directed against cirrhosis associated sarcopaenia will require prospective research.
