# Efficacy and safety of rifaximin in preventing hepatic encephalopathy: A systematic review and meta-analysis

## TL;DR

This study finds that rifaximin is effective and safe for preventing hepatic encephalopathy in patients with cirrhosis.

## Contribution

The study provides a meta-analysis of rifaximin's efficacy and safety in preventing hepatic encephalopathy compared to other treatments.

## Key findings

- Rifaximin reduces the risk of hepatic encephalopathy by 42% in primary prevention.
- Rifaximin is more effective than placebo and has fewer side effects like diarrhea compared to non-absorbable disaccharides.
- Rifaximin reduces the recurrence risk of hepatic encephalopathy by 51% in secondary prevention.

## Abstract

Rifaximin (RFX) is recommended for the treatment of hepatic encephalopathy (HE). However, evidence on whether RFX application could yield additional benefits for preventing HE in patients with cirrhosis is limited. In this study, we aimed to assess the safety and efficacy of RFX in preventing HE. We conducted a systematic search of randomized controlled trials to evaluate the use of RFX by analyzing HE incidence, hospitalization, all-cause mortality, and adverse events. Compared with the control group, RFX had a beneficial effect on the primary prevention of HE (RR = 0.58, 95% CI: 0.50–0.68), with noncomparable effects to NADs (including lactulose and lactitol, RR = 0.65, 95% CI: 0.38–1.11), but more effective than placebo (RR = 0.57, 95% CI: 0.47–0.69). After more than 1 month of RFX treatment, the risk of HE decreased significantly (RR = 0.55, 95% CI: 0.47–0.65). In secondary prevention of HE, RFX decreased the recurrence risk (RR = 0.49, 95% CI: 0.40–0.61). RFX helped to reduce the incidence of HE after transjugular intrahepatic portosystemic stent shunt (TIPSS) (RR = 0.70, 95% CI: 0.51–0.96). In terms of adverse effects, RFX was associated with a lower risk of diarrhea than NADs (RR = 0.04, 95% CI: 0.00–0.25). So, RFX therapy is effective and well-tolerated in preventing HE, and can be used as the first choice in the prophylaxis of HE after TIPSS.