Terlipressin is a synthetic 12-amino acid vasopressin analogue that acts via the vasopressin V1 receptor as a systemic vasoconstrictor. Terlipressin is the most widely-studied agent for HRS type 1 treatment published to-date1,2,7,9.
In Hepatorenal Syndrome (HRS) patients, the V1 mediated vasoconstriction particularly in the splanchnic area, results in decreased portal blood flow, an increase in mean arterial pressure, normalization of endogenous vasoconstrictor systems, increased renal blood flow and perfusion pressure. These effects are thought to potentially lead to improved renal function and even reversal of HRS-1, thereby providing the therapeutic rationale for treatment3,4,5,8,9.
Terlipressin is not approved by the FDA for use in the U.S. Outside the U.S., Canada, and Japan terlipressin has been approved for esophageal variceal hemorrhage in patients with liver cirrhosis for more than three decades. More recently, it was also approved in many countries for the treatment of patients with HRS type 1.
Hepatorenal Syndrome (HRS) is a rare disease and is characterized by rapidly progressing, potentially reversible, kidney failure in patients with decompensated liver cirrhosis. HRS-1 is often fatal within weeks to months3,4,5,6,9.
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1 Sanyal AJ, Boyer TD, Garcia-Tsao G, Regenstein F, Rossaro L, Appenrodt B, Blei A, Gülberg V, Sigal S, Teuber P and the Terlipressin Study Group. A randomized, prospective, double-blind, placebo controlled trial of terlipressin for type 1 hepatorenal syndrome. Gastroenterology. 2008134:1360-1368.
2 Martín-Llahí M, Pépin M-N, Guevara M, Díaz, F, Torre A, Monescillo A, et al. Terlipressin and albumin vs albumin in patients with cirrhosis and hepatorenal syndrome: a randomized study. Gastroenterology. 2008134:1352-1359
3 Arroyo V, Gine`s P, Gerbes AL, Dudley FJ, Gentilini P, Laffi G, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 199623:164-176.
4 Arroyo V, Terra C, Gine`s P. Advances in the pathogenesis and treatment of type-1 and type-2 hepatorenal syndrome. J Hepatol 200746:935-946.
5 Salerno F, Gerbes A, Gines P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. A consensus workshop of The International Ascites Club. Gut. 2007 Sep56(9):1310-18.
6 Boyer T. D., Sanyal A. J., Garcia-Tsao G., Regenstein F., Rossaro L., Appenrodt B., Gülberg V., Sigal S., Bexon, A., Teuber P. and the Terlipressin Study Group. Liver Transplantation 17:1328-1332, 2011
7 Gluud LL, Christensen K, Christensen E, Krag A. Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 201051: 576-584.
8 Fagundes C. Gines P. Hepatorenal Syndrome: A Severe, but Treatable, Cause of Kidney Failure in Cirrhosis American Journal of Kidney Diseases 2012: Apr 4
9 Wong F. et. al. Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome. N Engl J Med 2021818-28
