P4591 - Trends in the Early Adoption of Terlipressin Among Hospitalized Adults with Hepatorenal Syndrome in the U.S.: A Real-World Analysis

Robert Wong, MD, MS, FACG¹, Andrew S. Allegretti, MD, MSc², Xingyue Huang, PhD³, Mary P. Panaccio, PhD, MS³, Sanaz Cardoza, PharmD³, John Niewoehner, PharmD³, Rahul Rajkumar, MD, MPH⁴, Jonathan Lilley, BA⁵, Kunal Lodaya, MD^5
1Stanford/VA Palo Alto, Palo Alto, CA; ²Massachusetts General Hospital, Boston, MA; ³Mallinckrodt Pharmaceuticals, Bridgewater, NJ; ⁴Boston Strategic Partners, Boston, MA; ⁵Boston Strategic Partners, Philadelphia, PA

Introduction: Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a serious complication of decompensated liver cirrhosis, leading to significant morbidity and mortality. Terlipressin is the only FDA-approved treatment for adults with HRS and is a preferred therapy according to national and international guidelines. We evaluated real-world trends and outcomes in hospitalized U.S. patients with HRS treated with terlipressin.

Methods: A HIPAA-compliant, hospital chargemaster database (Premier), was queried to identify patients hospitalized with HRS and treated with terlipressin for ≥ 2 days between Sep 2022 - May 2024. HRS diagnoses and terlipressin administration were identified using ICD-10-CM/PCS, National Drug Codes, and billing codes. Socio-demographics, clinical characteristics, terlipressin treatment patterns, and clinical outcomes were evaluated.

Results: A total of 125 patients were included. Mean age was 55.4y ± 12.5, 67.2% were male, 64.8% were White (non-Hispanic), 17.6% were Hispanic, and 8.8% were Black/African American (non-Hispanic). Nearly all patients had an index hospitalization classified as emergent/urgent (97.6%), 84.8% sought care from teaching hospitals, and 64.8% were treated at large hospitals with 500+ beds. The most common etiology of cirrhosis was alcohol-related liver disease (ALD, 74.4%). On average (SD), terlipressin was initiated on day 6 (6.7) of hospitalization, and only 20.8% (n= 26) received terlipressin as 1^st line treatment; 78.4% were treated first with midodrine or octreotide (53.6% received both), and 11.2% with norepinephrine (not mutually exclusive). Average (SD) terlipressin treatment duration was 4.8 (4.8) days. Based on a subset of n= 21 with serum creatinine (SCr) measurements and a baseline SCr > 1.5 mg/dL at admission (mean [SD]: 3.3 [1.1]), HRS reversal, defined as the return of pre-treatment SCr to ≤ 1.5 mg/dL, was seen in n= 10 (47.6%), with a mean (SD) post-treatment SCr of 1.2 (0.2) mg/dL. Overall, 45.6% were discharged to home or a home health organization. In-hospital mortality was 17.6%, and 16.8% were discharged to hospice care. The median (IQR) length of hospitalization was 15 days (9 – 25).

Discussion: In the first post-approval evaluation of terlipressin real-world treatment and outcomes in the U.S., the majority of HRS patients were treated at large academic centers and had underlying ALD. Overall mortality was 17.6%, and while terlipressin was used 1^st line in only 20.8% of patients, 47.6% of patients with SCr data achieved HRS reversal.


Disclosures:


Robert Wong, MD, MS, FACG¹, Andrew S. Allegretti, MD, MSc², Xingyue Huang, PhD³, Mary P. Panaccio, PhD, MS³, Sanaz Cardoza, PharmD³, John Niewoehner, PharmD³, Rahul Rajkumar, MD, MPH⁴, Jonathan Lilley, BA⁵, Kunal Lodaya, MD⁵. P4591 - Trends in the Early Adoption of Terlipressin Among Hospitalized Adults with Hepatorenal Syndrome in the U.S.: A Real-World Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.