Patients with refractory ascites treated with alfapump® system have better health-related quality of life as compared to those treated with large volume paracentesis: the results of a multicenter randomized controlled study

Maria Stepanova, Fatema Nader, Christophe Bureau, Danielle Adebayo, Laure Elkrief, Dominique Valla, Markus Peck-Radosavljevic, Anne McCune, Victor Vargas, Macarena Simon-Talero, Juan Cordoba, Paolo Angeli, Silvia Rossi, Stewart MacDonald, Jeroen Capel, Rajiv Jalan, Zobair M. Younossi

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17 Citations (Scopus)

Abstract

© 2018, Springer International Publishing AG, part of Springer Nature. Background: Refractory ascites (RA) is a complication of cirrhosis which is treated with large volume paracentesis (LVP) as the standard of care. Alfapump® system is a fully implantable pump system which reduces the need for LVP. The aim was to assess health-related quality of life (HRQL) in patients treated with alfapump® versus LVP. Methods: The data were collected in a multicenter open-label randomized controlled trial (clinicaltrials.gov #NCT01528410). Subjects with cirrhosis Child–Pugh class B or C accompanied by RA were randomized to receive alfapump® or LVP. The SF-36v2 and CLDQ scores were compared between the two treatment arms at screening and monthly during treatment. Results: Of 60 subjects randomized, HRQL data were available for 58 (N = 27 received alfapump® and N = 31 received LVP only). At baseline, no differences were seen between the treatment arms (all p > 0.05): age 61.9 ± 8.4, 79.3% male, MELD scores 11.7 ± 3.3, 85.2% Child–Pugh class B, 70.7% had alcoholic cirrhosis. The mean number of LVP events/subject was lower in alfapump® than LVP (1.1 vs. 8.6, p < 0.001). The HRQL scores showed a moderate improvement from the baseline levels in subjects treated with alfapump® (p < 0.05 for abdominal and activity scores of CLDQ) but not with LVP (all one-sided p > 0.05) in the first 3 months. Multivariate analysis showed that treatment with alfapump® was independently associated with better HRQL at 3 months (total CLDQ score: beta = 0.67 ± 0.33, p = 0.05). Conclusion: As compared to LVP, the use of alfapump® system is associated with both a reduction in the number of LVP events and improvement of health-related quality of life.
Original languageEnglish
Pages (from-to)1513-1520
JournalQuality of Life Research
Volume27
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Keywords

  • Alcoholic liver disease
  • Cirrhosis
  • Decompensation
  • MELD

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    Stepanova, M., Nader, F., Bureau, C., Adebayo, D., Elkrief, L., Valla, D., Peck-Radosavljevic, M., McCune, A., Vargas, V., Simon-Talero, M., Cordoba, J., Angeli, P., Rossi, S., MacDonald, S., Capel, J., Jalan, R., & Younossi, Z. M. (2018). Patients with refractory ascites treated with alfapump® system have better health-related quality of life as compared to those treated with large volume paracentesis: the results of a multicenter randomized controlled study. Quality of Life Research, 27(6), 1513-1520. https://doi.org/10.1007/s11136-018-1813-8