1-day on par with 5-day octreotide in preventing bleeding, death from esophageal varices

A 1-day regimen of octreotide infusion, along with endoscopic therapy for variceal bleeding, does not appear to be inferior to the standard 5-day regimen in the prevention of rebleeding and all-cause mortality at 6 weeks, according to the preliminary results of a study.

“Variceal bleeding represents a critical complication with high mortality,” said lead author Dr Kanit Bunnag from Phramongkutklao Hospital and College of Medicine, Thailand, who presented the study at DDW 2024. “Baveno VII recommends vasoactive agents to achieve hemostasis and prevent rebleeding.”

Bunnag and colleagues conducted this nationwide, multicentre, noninferiority, randomized control trial to compare the efficacy of 1 day versus 5 days of octreotide infusion, following a successful endoscopic therapy, in averting early rebleeding at 5 days, rebleeding at 6 weeks, and all-cause death at 6 weeks.

A total of 151 patients with acute variceal bleeding who underwent endoscopic therapy were randomly assigned to receive either 1 day (n=76) or 5 days (n=75) of continuous octreotide infusion (50 μg/hr). The authors then assessed early rebleeding (5-day treatment failure of index bleed according to Baveno VII consensus guideline), transfusion requirement, and mortality.

Majority of the participants were male (1-day vs 5-day regimen: 65 percent vs 62 percent; p=0.631), with a mean age of 55 years. [DDW 2024, abstract 300]

Noninferior

Early rebleeding (1.3 percent vs 1.3 percent; p=0.99) and 6-week rebleeding (9.2 percent vs 9.3 percent; p=0.97) were comparable between the 1-day and 5-day regimens, while all-cause mortality at 6 weeks did not significantly differ between the two groups (7.8 percent vs 5.3 percent; p=0.74).

Additionally, patients in the 1-day regimen group had fewer transfusion requirements (prior to endoscopy: median 1 packed red cell unit used; following endoscopy: median 0 packed red cell unit used), a substantially shorter time to solid diet initiation (median 24 hours, range 20‒24 hours), and a significantly reduced length of stay (median 5 days).

On the other hand, slightly more patients in the 1-day regimen group were prescribed beta-blockers at discharge (69 percent vs 66 percent; p=0.578). In terms of the type of beta-blocker therapy used, carvedilol appeared to contribute to a higher rate of all-cause death when compared with propranolol (12.1 percent vs 1.9 percent; p=0.031).

Notably, the use of proton pump inhibitor following endoscopy did not seem to result in a lower risk of variceal bleeding or adverse events in this population.

Predictors

In multivariate analysis, the following factors were predictive of increased all-cause mortality at 6 weeks: hepatic encephalopathy grade 3/4 (adjusted odds ratio [aOR], 99.78, 95 percent confidence interval [CI], 1.02‒9,743.06; p=0.049) and the absence of beta-blocker prescription at discharge (aOR, 11.11, 95 percent CI, 1.13‒108.62; p=0.038).

“The 1-day regimen of octreotide infusion, following successful endoscopic therapy for variceal bleeding, demonstrates no inferiority compared to the standard 5-day regimen in preventing early rebleeding, 6-week rebleeding, and 6-week all-cause mortality,” Bunnag said.