Carvedilol outdoes nadolol, propranolol in preventing decompensation events in cirrhosis

Treatment with carvedilol, compared with nadolol or propranolol, results in reduced rates of major decompensation events among patients with cirrhosis, a study has shown.

A team of investigators identified adults with cirrhosis initiating carvedilol, nadolol, or propranolol using a US administrative claims database from 2013 to 2025.

The primary outcome was a composite of hospitalization for major decompensation (ascites, spontaneous bacterial peritonitis [SBP], hepatorenal syndrome [HRS], hepatic encephalopathy, or variceal haemorrhage).

The investigators estimated the absolute risk differences (RDs) and risk ratios (RRs) at 6 months of follow-up using inverse probability of treatment weighting accounting for 129 pre-exposure covariates.

At 6 months, initiators of carvedilol showed a lower risk for major decompensation events than those treated with nadolol (RD, ‒3.69 percentage points, 95 percent confidence interval [CI], ‒5.33 to ‒2.09; RR, 0.80, 95 percent CI, 0.72‒0.88) or propranolol (RD, ‒2.88 percentage points, 95 percent CI, ‒4.29 to ‒1.49; RR, 0.83, 95 percent CI, 0.76‒0.90).

Specifically, reduced risks were noted for variceal haemorrhage (RD vs nadolol, ‒3.51 percentage points, 95 percent CI, ‒4.79 to ‒2.20; RD vs propranolol, ‒1.65 percentage points, 95 percent CI, ‒2.71 to ‒0.59) and ascites, SBP, or HRS (RD vs nadolol, ‒3.05 percentage points, 95 percent CI, ‒4.52 to ‒1.75; RD vs propranolol, ‒1.58 percentage points, 95 percent CI, ‒2.77 to ‒0.44).

“In cirrhosis, nonselective β-blockers (ie, carvedilol, nadolol, and propranolol) reduce hepatic portal pressure and have demonstrated benefit vs placebo for preventing decompensation,” the investigators said.