Efficacy of vasopressin V2 receptor antagonist tolvaptan in treatment of hepatic edema

Aim Tolvaptan, oral active vasopressin V2 receptor antagonist is widely used for hepatic edema in Japan, but its clinical benefits have yet to be fully clarified. Present study evaluated the efficacy of tolvaptan in hepatic edema. Methods The efficacy and treatment regimen of tolvaptan were evaluated in 150 patients with hepatic edema by analyzing the initial (day14) and long-term (day 90) responses to the drug and their predictive factors. All patients were divided into good (Child-Pugh classification B, and absent of advanced hepatocellular carcinoma) and poor hepatic condition groups, and the response rates were compared between the two groups. Results The initial response rate was 62%, and the long-term response rate was 47%. The assessment of predictive factors for response to tolvaptan showed that serum creatinine and C-reactive protein levels were important predictors of initial response, and that hepatic conditions, such as the Child-Pugh score, or presence of hepatocellular carcinoma, as well as initial response were significant predictors of long-term response. In addition, both the initial and long-term response rates and the cumulative survival rate were found to be higher in the good hepatic condition group than in the poor hepatic condition group, respectively (71% vs. 57%, P = 0.113; 62% vs. 39%, P = 0.009; Log-rank test, P < 0.001). Conclusions These results suggest that tolvaptan may provide high response rates when used early in the course of hepatic edema, or when both hepatic and renal functions are still retained, leading to an improved disease prognosis.