单位：[1]School of Medicine Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, No. 145, Middle Shandong Road, Shanghai, 200001, China[2]Tianjin Third Hospital, Tianjin, China[3]Southwest Hospital, Chongqing, China[4]Beijing Ditan Hospital, Capital Medical University, Beijing, China[5]Beijing Youan Hospital, Capital Medical University, Beijing, China[6]Henan Provincial Peoples Hospital, Zhengzhou, China[7]Shanghai Public Health Clinical Center, Shanghai, China[8]The First Hospital of Jilin University, Changchun, China[9]The First Affiliated Hospital, Zhejiang University, Hangzhou, China浙江大学医学院附属第一医院[10]85 Hospital of Peoples Liberation Army, Shanghai, China[11]Beijing Friendship Hospital, Capital Medical University, Beijing, China首都医科大学附属北京友谊医院[12]Qingdao Municipal Hospital, Qingdao, China[13]The First Affiliated Hospital of Nanchang University, Nanchang, China[14]Shanghai Shuguang Hospital, Shanghai, China
BackgroundTo determine the safety and efficacy of different doses of tolvaptan for treating Chinese cirrhotic patients with or without hyponatraemia who still had ascites after routine therapy with diuretics.MethodsIn the present placebo-controlled, randomized, double-blinded, multicentre clinical trial, patients with cirrhotic ascites who failed to adequately respond to a combination of an aldosterone antagonist plus an orally administered loop diuretic were randomly placed at a 4:2:1 ratio into 3 groups [the 15 mg/day tolvaptan group (N=301), 7.5 mg/day tolvaptan group (N=153) and placebo group (N=76)] for 7 days of treatment. The effects and safety were evaluated on days 4 and 7. A change in body weight from baseline on day 7 of treatment was the primary endpoint.ResultsThe administration of 7.5 or 15 mg/day tolvaptan significantly decreased body weight from baseline on day 7 of treatment compared to that with placebo treatment (P=0.026; P=0.001). For the secondary endpoints, changes in abdominal circumference from baseline and improvements in ascites were markedly different in the treatment groups and the placebo group on day 7 (P-7.5=0.05, P-15.0=0.002 and P-7.5=0.037, P-15.0=0.003), but there was no difference between the 7.5 mg/day and 15 mg/day dosage groups. The 24-h cumulative urine volume was higher in the 7.5 mg/day and 15 mg/day tolvaptan groups than the placebo group (P=0.002, P<0.001) and was greater in the 15 mg/day tolvaptan group than the 7.5 mg/day tolvaptan group (P=0.004). Sodium serum concentrations were higher in patients with hyponatraemia after tolvaptan treatment, with no significant difference between the two dosage groups. The incidence of serious adverse drug reactions was not different between the groups (P=0.543).ConclusionsTolvaptan treatment at 7.5 mg per day might be a good therapeutic choice for Chinese cirrhotic patients with ascites who did not achieve satisfactory clinical responses to previous treatment regimens with combination therapy with an aldosterone antagonist and an orally administered loop diuretic.Trial registrationNCT01349348. Retrospectively registered May 2011.
基金：
Zhejiang Otsuka Pharmaceuticals Co., Ltd.; Otsuka Beijing Research Institute
第一作者单位：[1]School of Medicine Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, No. 145, Middle Shandong Road, Shanghai, 200001, China
共同第一作者：
通讯作者：
推荐引用方式(GB/T 7714)：
Jieting Tang,Yongfeng Wang,Tao Han,et al.Tolvaptan therapy of Chinese cirrhotic patients with ascites after insufficient diuretic routine medication responses: a phase III clinical trial[J].BMC GASTROENTEROLOGY.2020,20(1):doi:10.1186/s12876-020-01536-0.
APA：
Jieting Tang,Yongfeng Wang,Tao Han,Qing Mao,Jun Cheng...&Yimin Mao.(2020).Tolvaptan therapy of Chinese cirrhotic patients with ascites after insufficient diuretic routine medication responses: a phase III clinical trial.BMC GASTROENTEROLOGY,20,(1)
MLA：
Jieting Tang,et al."Tolvaptan therapy of Chinese cirrhotic patients with ascites after insufficient diuretic routine medication responses: a phase III clinical trial".BMC GASTROENTEROLOGY 20..1(2020)
