Rowe, Ian A; Villanueva, Càndid; Shearer, Jessica E; Torres, Ferran; Albillos, Agustín; Genescà, Joan; Garcia-Pagan, Joan C; Tripathi, Dhiraj; Hayes, Peter C; Bosch, Jaume; Abraldes, Juan G (2023). Quantifying the benefit of non-selective beta-blockers in the prevention of hepatic decompensation: a Bayesian re-analysis of the PREDESCI trial. Hepatology, 78(2), pp. 530-539. Wolters Kluwer 10.1097/HEP.0000000000000342
Full text not available from this repository. (Request a copy)BACKGROUND AND AIMS
Beta-blockers have been studied for the prevention of variceal bleeding and, more recently, for the prevention of all cause decompensation. Some uncertainties regarding the benefit of beta-blockers for the prevention of decompensation remain. Bayesian analyses enhance the interpretation of trials. The purpose of this study was to provide clinically meaningful estimates of both the probability and magnitude of benefit with beta-blocker treatment across a range of patient types.
APPROACH AND RESULTS
We undertook a Bayesian re-analysis of PREDESCI incorporating three priors (moderate neutral, moderate optimistic, and weak pessimistic). The probability of clinical benefit was assessed considering the prevention of all cause decompensation. Microsimulation analyses were done to determine the magnitude of benefit. In the Bayesian analysis the probability that beta-blockers reduce all cause decompensation was >0.93 for all priors. The Bayesian posterior hazard ratios (HR) for decompensation ranged from 0.50 (optimistic prior, 95% credible interval 0.27-0.93) to 0.70 (neutral prior, 95% credible interval 0.44-1.12). Exploring the benefit of treatment using microsimulation highlights substantial treatment benefit. For the neutral prior derived posterior HR and a 5% annual incidence of decompensation, at 10 years an average of 497 decompensation-free years per 1000 patients were gained with treatment. In contrast, at 10 years 1639 years per 1000 patients were gained from the optimistic prior derived posterior HR and a 10% incidence of decompensation.
CONCLUSIONS
Beta-blocker treatment is associated with a high probability of clinical benefit. This likely translates to a substantial gain in decompensation-free life years at the population level.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology |
UniBE Contributor: |
Bosch Genover, Jaime |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1527-3350 |
Publisher: |
Wolters Kluwer |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Mar 2023 13:53 |
Last Modified: |
18 Jul 2023 00:12 |
Publisher DOI: |
10.1097/HEP.0000000000000342 |
PubMed ID: |
36897269 |
URI: |
https://boris.unibe.ch/id/eprint/179896 |
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