# Real-World Indirect Treatment Comparison of Terlipressin vs Midodrine Plus Octreotide in Hepatorenal Syndrome-Acute Kidney Injury

## TL;DR

This study compares terlipressin and midodrine plus octreotide for treating liver-related kidney injury in the UK and US, finding terlipressin more effective.

## Contribution

The study provides real-world evidence comparing terlipressin and midodrine plus octreotide for HRS-AKI in the UK and US.

## Key findings

- Terlipressin achieved HRS reversal in 53.2% of patients compared to 16.9% with midodrine plus octreotide.
- Terlipressin led to a significant decrease in serum creatinine, unlike midodrine plus octreotide.
- Differences in treatment and outcomes are attributed to the historical standard of care in the US.

## Abstract

Evidence on the comparative real-world effectiveness of terlipressin vs midodrine plus octreotide (MO) for hepatorenal syndrome-acute kidney injury (HRS-AKI) in the United Kingdom and the United States is limited.

Using individual-level chart review data for patients across the United Kingdom (2013–2017) and the United States (2016–2019), an indirect treatment comparison was conducted comparing the efficacy of terlipressin (UK cohort) with MO (US cohort). Covariate balancing propensity scoring matched the cohorts on baseline serum creatinine (SCr), presence of encephalopathy and/or ascites, albumin use and duration, age, and sex. The primary endpoint was HRS reversal, defined as achieving SCr ≤1.5 mg/dL by the last day of treatment.

At treatment initiation, 90.2% of UK patients received terlipressin (194/215), while 89.2% of US patients received MO (140/157). Concomitant albumin was administered in 67.9% of UK and 98.7% of US patients. In a covariate balancing propensity score-adjusted cohort, HRS reversal was achieved in 53.2% of terlipressin-treated patients (the United Kingdom, weighted effective sample size of 75) compared with 16.9% of MO-treated patients (the United States, n = 89) (adjusted mean difference (95% CI) 36.3% (22.4, 50.2), P < 0.0001). In adjusted analysis, individuals treated with terlipressin experienced an overall reduction in SCr at completion of treatment (SCr decrease 1.00 mg/dL vs increase of 0.08 mg/dL for MO-treated patients, P < 0.0001).

HRS-AKI treatment and outcomes differ between the United Kingdom and the United States, attributed to the historical standard of care MO in the United States. In adjusted analyses, real-world use of terlipressin was more effective than MO at improving kidney function and achieving HRS-AKI reversal.