Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 18, 2017; 9(5): 270-277
Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.270
Addition of simvastatin to carvedilol non responders: A new pharmacological therapy for treatment of portal hypertension
Zeeshan Ahmad Wani, Sonmoon Mohapatra, Afaq Ahmad Khan, Ashutosh Mohapatra, Ghulam Nabi Yatoo
Zeeshan Ahmad Wani, Department of Gastroenterology and Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Sonmoon Mohapatra, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School/Saint Peters University Hospital, New Brunswick, NJ 08901, United States
Afaq Ahmad Khan, Department of Hematology and Oncology, JLNM hospital, Srinagar, Kashmir 190002, India
Ashutosh Mohapatra, Department of Gastroenterology and Hepatology, AMRI Hospitals, Bhubaneswar 751019, India
Ghulam Nabi Yatoo, Department of Gastroenterology and Hepatology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India
Author contributions: The work was carries out in collaboration of all authors; Wani ZA designed the study, performed the research and analyzed the data; Wani ZA and Mohapatra S wrote the first draft of the article; Khan AA and Yatoo GN made critical revisions related to important intellectual content of the manuscript; Mohapatra S and Mohapatra A edited and revised the manuscript for final submission.
Institutional review board statement: The study was reviewed and approved by Sher-i-Kashmir Institute of Medical Sciences Medical College, Srinagar, Jammu and Kashmir 190011, India and was conducted in Sher-i-Kashmir Institute of Medical Sciences Medical College, Srinagar and Noora Multispecialty Hospital, Srinagar, Kashmir, India.
Informed consent statement: All included patients gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: The Authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: 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/
Correspondence to: Sonmoon Mohapatra, MD, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School/Saint Peters University Hospital, 254 Easton Ave, New Brunswick, NJ 08901, United States. sonmoon0mohapatra@gmail.com
Telephone: +1-732-7458600
Received: November 13, 2016
Peer-review started: November 15, 2016
First decision: December 1, 2016
Revised: December 15, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: February 18, 2017
Processing time: 95 Days and 10.9 Hours
Abstract
AIM

To determine whether addition of simvastatin could be an important pharmacological rescue therapy for carvedilol non-responders.

METHODS

One hundred and two consecutive patients of cirrhosis of liver with significant portal hypertension were included. Hepatic venous pressure gradient (HVPG) was measured at the base line and after proper optimization of dose; chronic response was assessed at 3 mo. Carvedilol non-responders were given simvastatin 20 mg per day (increased to 40 mg per day at day 15). Carvedilol plus simvastatin was continued for 1 mo and hemodynamic response was again measured at 1 mo.

RESULTS

A total of 102 patients with mean age of 58.3 ± 6.6 years were included. Mean baseline HVPG was 16.75 ± 2.12 mmHg and after optimization of dose and reassessment of HVPG at 3 mo, mean reduction of HVPG from baseline was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and non-responders respectively (P < 0.001). Addition of simvastatin to carvedilol non-responders resulted in significant response in 16 patients (42.1%) and thus overall response with carvedilol and carvedilol plus simvastatin was seen in 78 patients (80%). Two patients were removed in chronic protocol study with carvedilol and three patients were removed in carvedilol plus simvastatin study due to side effects.

CONCLUSION

Addition of simvastatin to carvedilol non-responders may prove to be an excellent rescue therapy in patients with portal hypertension.

Keywords: Simvastatin; Cirrhosis; Carvedilol; Liver cirrhosis; Portal hypertension; Hepatocellular carcinoma

Core tip: There is no pharmacological option available for treatment of carvedilol nonresponders in patients with portal hypertension. Addition of simvastatin could be an important pharmacological rescue therapy for carvedilol nonresponders. This study showed that addition of simvastatin to carvedilol non responders can increase overall response to around 80%, which is one of the best possible pharmacologically produced chronic response and it opens a new strategy for portal hypertension treatment.