“Hepatic encephalopathy (HE) is a frequent complication and one of the most debilitating manifestations of liver disease”
“Overt hepatic encephalopathy will occur in 30-40% of those with cirrhosis at some time during their clinical course”
The guidelines recommend rifaximin-α (with lactulose) to maintain remission in patients who have experienced one or more bouts of overt hepatic encephalopathy.
View the full AASLD/EASL guidanceNational Institute for Health and Care Excellence (NICE) NG50: Cirrhosis in over 16s: assessment and management 2
“Hepatic encephalopathy is a major complication of cirrhosis.”
“Approximately 50% of people with cirrhosis will develop clinically apparent hepatic encephalopathy at some stage after diagnosis – the risk being around 5-25% within 5 years.”
“Hospital admissions are common and inpatient stays often prolonged. The presence of hepatic encephalopathy is associated with a significant increase in mortality; survival after the first episode is 42% at 1 year and 23% at 3 years.”
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View the full NG50 guidance
NICE TA337 guidance 3 for preventing episodes of overt hepatic encephalopathy with XIFAXAN® 550 (rifaximin-α)
Section 1.1 recommends rifaximin-α, within its marketing authorisation, as an option for reducing the recurrence of episodes of overt hepatic encephalopathy in people aged 18 years or older. 3
“Expert clinical opinion suggests that rifaximin-α is effective in reducing the recurrence of hepatic encephalopathy episodes and is well tolerated. Treatment with rifaximin-α may improve quality of life, prevent readmissions to hospital and reduce morbidity and carer burden.” 4
Evidence supporting HE management with rifaximin-α around the UK:
Scottish Medicines Consortium (SMC): Rifaximin-α (XIFAXAN®) is accepted for use within NHS Scotland. 5
National Centre for Pharmacoeconomics (NCPE) Ireland: Product accepted but full pharmacoeconomic evaluation not recommended 6
The Department of Health Social Services and Public Safety (DHSSPS) DHSSPS have endorsed NICE TA337 in Northern Ireland. 7/sup>
All Wales Medicines Strategy Group (AWMSG): Product meets exclusion criteria due to positive NICE appraisal. 8
The guidelines recommend rifaximin-α as an additive to lactulose in the secondary prophylaxis of HE > grade 1 according to West Haven criteria without trigger, if a relapse has occurred with lactulose alone (recommendation 7.23).
View the full DGVS guidance
Hepatic encephalopathy – Danish Society for Gastroenterology and Hepatology (DSGH) 10
The guidelines recommend rifaximin-α twice daily as a supplement to lactulose after the second episode of OHE.
View the full DSGH guidance