| Theme |
Cirrhosis -- Recent Progress in Diagnosis and Treatmen |
| Title |
Therapeutic Advances in Hepatic Edema Treatment with Arginine Vasopressin (AVP) V2 Receptor Antagonists |
| Author |
Mikio Yanase |
Department of Gastroenterology, National Center for Global Health and Medicine |
| Author |
Yuichi Nozaki |
Department of Gastroenterology, National Center for Global Health and Medicine |
| Author |
Shintaro Mikami |
Department of Gastroenterology, National Center for Global Health and Medicine |
| Author |
Naohiko Masaki |
Center for Hepatitis and Immunology, National Center for Global Health and Medicine |
| [ Summary ] |
Liver cirrhosis is associated with forms of hepatic edema such as intractable ascites and/or lower limb edema. A new orally effective nonpeptide arginine vasopressin (AVP) V2 receptor antagonist, tolvaptan, was recently approved for Japanese patients with hepatic edema. In a phase 3, randomized, placebo-controlled trial, administration of 7.5 mg/day of tolvaptan in addition to conventional diuretics therapy was effective in changing bodyweight from the baseline, changing ascites volume, improving rates of lower limb edema, and/or improving ascites-related clinical symptoms. A possible adverse event with the use of AVP V2-receptor antagonists is a rapid rise in serum sodium, leading to hypernatremia and central nervous system injury. Administration should be limited to inpatient settings. These effects have not been confirmed with the use of these antagonists as compared to conventional therapy for long-term management of hepatic edema. A novel marker and/or criteria which could predict responders or non-responders to these antagonists is hoped for. |