Efficacy and safety of rifaximin in preventing hepatic encephalopathy: A systematic review and meta-analysis

Rifaximin (RFX) is recommended for the treatment of hepatic encephalopathy (HE). However, evidence on whether RFX application could yield additional benefits for preventing HE in patients with cirrhosis is limited. In this study, we aimed to assess the safety and efficacy of RFX in preventing HE. We conducted a systematic search of randomized controlled trials to evaluate the use of RFX by analyzing HE incidence, hospitalization, all-cause mortality, and adverse events. Compared with the control group, RFX had a beneficial effect on the primary prevention of HE (RR = 0.58, 95% CI: 0.50–0.68), with noncomparable effects to NADs (including lactulose and lactitol, RR = 0.65, 95% CI: 0.38–1.11), but more effective than placebo (RR = 0.57, 95% CI: 0.47–0.69). After more than 1 month of RFX treatment, the risk of HE decreased significantly (RR = 0.55, 95% CI: 0.47–0.65). In secondary prevention of HE, RFX decreased the recurrence risk (RR = 0.49, 95% CI: 0.40–0.61). RFX helped to reduce the incidence of HE after transjugular intrahepatic portosystemic stent shunt (TIPSS) (RR = 0.70, 95% CI: 0.51–0.96). In terms of adverse effects, RFX was associated with a lower risk of diarrhea than NADs (RR = 0.04, 95% CI: 0.00–0.25). So, RFX therapy is effective and well-tolerated in preventing HE, and can be used as the first choice in the prophylaxis of HE after TIPSS.