Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Lupin, Norgine, ASKA Pharma - LARVOL DELTA

Incidence and efficacy of strategies for preventing hepatic encephalopathy following transjugular intrahepatic portosystemic shunt: A meta-analysis. (PubMed, World J Hepatol) - "The HE incidence after TIPS was relatively high, and the use of drugs after TIPS may reduce the HE incidence. However, research, especially large-scale randomized controlled trials, is still lacking."

Journal • Retrospective data • CNS Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis

Rifaximin-α use is associated with improved muscle mass in patients with cirrhosis. (PubMed, World J Hepatol) - "This study demonstrates a significant independent association between rifaximin-α therapy and muscle mass in patients with cirrhosis and HE. Prospective studies of rifaximin-α therapy examining its impact on sarcopenia are required to assess its potential therapeutic role in this cohort."

Journal • CNS Disorders • Fibrosis • Gastrointestinal Disorder • Hepatic Encephalopathy • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Oncology • Sarcopenia • Solid Tumor • Transplantation

Rifaximin use does not significantly affect the rate of 30-day mortality or liver transplant in patients with cirrhosis on Daptomycin in two national US-based cohorts (EASL 2025) - "Rifaximin users were younger, more likely to be on PPI, diuretics, lactulose & beta-blockers & had higher admission MELD- Na. In two large complementary US-based experiences, rifaximin use did not significantly impact 30-day mortality and was not a systematic barrier to LT in patients with cirrhosis on daptomycin therapy. This should be reassuring to clinicians after the recent report of potential rifaximin-induced resistance to daptomycin and shows that there is no real-world translation of this findings across large and diverse population experiences."

Clinical • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Transplantation

Pharmacologic treatment of irritable bowel syndrome. Position statement of the Asociación Mexicana de Gastroenterología, 2024. (PubMed, Rev Gastroenterol Mex (Engl Ed)) - "Overall, these recommendations provide a solid framework for personalizing treatment, based on the clinical characteristics of the Mexican patient with IBS."

Clinical guideline • Journal • Constipation • Gastroenterology • Gastrointestinal Disorder • Pain

Rifaximin-α in Patients With Recurrent Episodes of Hepatic Encephalopathy Due to Cirrhosis Reduces Healthcare Utilization. (PubMed, United European Gastroenterol J) - "Rifaximin-α significantly reduced the number of episodes of hepatic encephalopathy, the number of hospital admissions as well as the number of outpatient and emergency department visits, contributing to a reduction in healthcare utilization. There was no reduction in overall costs."

HEOR • Journal • Cardiovascular • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Hypertension • Immunology • Portal Hypertension

Impact of an Outpatient Rifaximin Access Program on 30-Day Readmission Rates in Hepatic Encephalopathy Patients Initiated on Rifaximin in the Inpatient Setting (ISPOR 2025) - "OBJECTIVES: Rifaximin, recommended for lactulose-refractory hepatic encephalopathy (HE), has been shown to reduce HE-related hospitalizations and healthcare costs. Following process streamlining, OCP-driven rifaximin access was associated with significantly decreasing rifaximin readmissions."

Clinical • CNS Disorders • Hepatic Encephalopathy • Hepatology

Impact of Post-Discharge Rifaximin Use Following an Overt Hepatic Encephalopathy (OHE) Hospitalization on Annual Rates of OHE Rehospitalization in the United States (ISPOR 2025) - "OBJECTIVES: Practice guidelines support rifaximin as an add-on to lactulose following breakthrough OHE for improved quality of care (QoC). Rifaximin use post-OHE-hospitalization-discharge was associated with a significant reduction in OHE rehospitalization rates, regardless of pre-index OHE medication use. These findings highlight the importance of timely rifaximin access post-discharge."

Clinical • CNS Disorders • Hepatic Encephalopathy • Hepatology

Rifaximin in Patients With Diabetic Gastroparesis (clinicaltrials.gov) - P2 | N=40 | Suspended | Sponsor: Mayo Clinic | Recruiting ➔ Suspended

Trial suspension • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Immunology • Inflammatory Bowel Disease

Simvastatin and Rifaximin for Decompensated Cirrhosis: A Hope Unfulfilled. (PubMed, Gastroenterology) - No abstract available

Journal • Fibrosis • Hepatology • Immunology

Fluoroquinolones for the Prophylaxis of Spontaneous Bacterial Peritonitis in Patients with Liver Cirrhosis: Are They Losing Ground? (PubMed, Life (Basel)) - "While norfloxacin remains a first-line prophylactic in cirrhotic patients with low ascitic protein levels, its efficacy appears to be reduced in those with advanced liver failure or additional risk factors for MDR organisms. In these subgroups, alternative prophylactics, such as trimethoprim-sulfamethoxazole or rifaximin, may be preferable. We propose a risk-stratification approach to guide treatment selection, with further studies needed to refine these criteria."

Journal • Review • Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Liver Failure

Treatment of Irritable Bowel Syndrome with Predominant Diarrhea (PubMed, Korean J Gastroenterol) - "Pharmacological treatments include antidiarrheal agents, such as loperamide, which reduce stool frequency but have limited effects on pain relief. Antispasmodics, such as octylonium bromide and hyoscine butylbromide, alleviate abdominal pain by modulating intestinal motility. Rifaximin, a non-absorbable antibiotic, has shown efficacy in symptom reduction by altering the gut microbiota. Selective serotonin receptor antagonists, such as ramosetron, have benefits in symptom control, particularly in male patients...Personalized treatment approaches are essential because IBS-D presents a wide spectrum of symptoms. Clinicians should tailor therapeutic plans based on individual patient characteristics, balancing the benefits and risks of each intervention to optimize symptom control and improve the quality of life."

Journal • Review • Gastrointestinal Disorder • Immunology • Pain

Identifying potential baseline risk factors for further decompensation in patients with cirrhosis and early decompensation: analysis of data from a phase 2 randomized trial (EASL 2025) - "Patients were randomly assigned to 24 weeks of treatment (6 arms; placebo/investigational rifaximin soluble solid dispersion tablets)... These trial data affirm that cirrhosis-related parameters, monitored to help determine patient prognosis (eg, MELD/MELD-Na score), identified patients with early DC at risk for further DC."

Clinical • P2 data • CNS Disorders • Diabetes • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Metabolic Disorders • Nephrology • Renal Disease

Mortality in patients hospitalised with decompensated cirrhosis and infection is associated with higher baseline measures of infection and organ dysfunction (EASL 2025) - "90-day mortality was not associated with prophylactic antibiotics or rifaximin, proton pump inhibitors or beta-blockers at trial entry... Our data show that disease severity and organ dysfunction are significantly associated with 90-day mortality in this cohort of patients hospitalised with decompensated cirrhosis and infection. Conventional markers for infection (WCC and CRP) appear to be the most useful predictive laboratory tests for infection severity. The significant association between 90-day mortality, baseline creatinine and syndecan-1 levels suggests there is a role for further studies examining the cardiorenal axis in decompensated cirrhosis."

Clinical • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Liver Failure • Nephrology • Renal Disease • CRP • SDC1

Transcatheter closure of acquired portosystemic shunts for the management of refractory hepatic encephalopathy. A case-series (EASL 2025) - "All patients were prescribed lactulose and 11/12 were prescribed rifaximin at the time of the procedure. Transcatheter closure of large SPSS for refractory HE appears safe and effective in this small case-series. Whilst clinical success is difficult to establish retrospectively, positive results include readmission for HE in fewer than half and at a mean interval of 10 months. Findings support use of targeted imaging reviewed by an experienced radiologist to identify accessible SPSS in patients with portal hypertension and refractory HE in settings where shunt closure is available."

Clinical • Cardiovascular • CNS Disorders • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension • Thrombosis

Efficacy and safety of fecal microbiota transplantation in patients with severe alcohol-related hepatitis or decompensated liver cirrhosis: a systematic review and meta-analysis (EASL 2025) - "Included studies involved adult patients with SAH or decompensated liver cirrhosis who received FMT versus SOC (nutritional support, lactulose and rifaximin, pentoxifylline, or corticosteroids). In patients with SAH/decompensated liver cirrhosis, FMT demonstrated short and long- term survival benefit over SOC. FMT use was also associated with lower rates of HE, ascites, and infection. To date, this is the most comprehensive systematic review that pooled efficacy and safety data related in FMT use in patients with SAH/chronic liver disease."

Retrospective data • Review • Addiction (Opioid and Alcohol) • CNS Disorders • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Liver Failure • Transplantation

Branched-chain amino acids in liver cirrhosis and hepatic encephalopathy: a meta-analysis of clinical evidence (EASL 2025) - "Control interventions included no treatment/placebo, diets, lactulose, or neomycin. BCAA supplementation improves HE symptoms. We found no effect on mortality. Few trials reported adverse events, quality of life, or nutritional status."

Retrospective data • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Psychiatry

Impact of parenteral nutrition on the risk of infections and the disease course of malnourished patients with decompensated liver cirrhosis (EASL 2025) - "Of note, a significantly ameliorated risk for oHE was detected in the HPN group compared to the controls (HR = 0.28; p = 0.03) after adjusting for rifaximin treatment in the multivariable competing risk model. The implementation of HPN in patients with advanced liver cirrhosis is not associated with an increased risk for overall infectious complications, although a linkage with a higher risk for bloodstream infections was detected. Furthermore, HPN may reduce the likelihood for oHE in malnourished patients with decompensated cirrhosis."

Clinical • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis

Randomized, open-label, phase 2a comparator study to assess the pharmacodynamics, safety and pharmacokinetics of oral administration of mnk6106 (l-ornithine phenylacetate) vs. rifaximin in subjects with hepatic cirrhosis and a previous history of hepatic encephalopathy (EASL 2025) - "Group B (L-OPA 4 g BID) showed the highest decrease in plasma AMM concentrations which was about 6 times greater than Rifaximin and this dose may be selected for future trials. All doses of L-OPA were safe and well tolerated."

Clinical • P2a data • PK/PD data • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Psychiatry

Impact of PPIs, PCABs, and Rifaximin on SBP risk in cirrhotic patients with moderate-to-severe ascites (EASL 2025) - "This study highlights the significant association between PCAB use and increased SBP risk in cirrhotic patients, while PPI and rifaximin use showed no such association. The findings underscore the importance of cautious prescribing of PCABs in this population to mitigate the risk of SBP. Tailored treatment strategies considering the differential effects of acid-suppressive therapies are warranted."

Clinical • Liver Cirrhosis

Outpatient sbp prophylaxis associates with higher sbp reccurence in a global cohort of cirrhosis inpatients with greatest impact in high- income countries (EASL 2025) - "Admission details: 14% were on SBPPr, 10% statins, 34% β-blockers, 44% PPI, 17% HBV antivirals, 25% rifaximin, & 44% on lactulose. Outpatient SBP prophylaxis is associated with a higher rate of SBP on admission, especially in high-income countries but not in lower-income countries in a global cohort of >7000 inpatients with cirrhosis."

Clinical • Cardiovascular • Diabetes • Fibrosis • Hepatology • Hypertension • Immunology • Infectious Disease • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis

Albumin infusion improves albumin binding capacity in patients with cirrhosis and MHE on gut-specific therapy (EASL 2025) - P2 | "Albumin binding capacity was impaired in patients with cirrhosis and MHE on lactulose and rifaximin, which was restored to normal levels in parallel with improvement in cognitive function after albumin administration. Our data suggested that albumin treatment could exert its beneficial effects through the restoration of albumin transport functionality, over and above traditional HE therapies."

Clinical • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology

Glycated albumin is increased in patients with cirrhosis and hepatic encephalopathy already on gut-directed therapy and links with cognitive and quality of life impairment (EASL 2025) - P2 | "Background and Aims: Cognitive impairment in cirrhosis can persist despite adequate treatment of HE with gut-directed therapies such as lactulose and rifaximin. Albumin from patients with cirrhosis and MHE even without diabetes shows higher glycation versus HC. These structural alterations contributed to decrease native albumin levels that could impair non-oncotic albumin functions in these patients."

Clinical • HEOR • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology

Shunt cross-sectional area is a better predictor of overt hepatic encephalopathy than minimal hepatic encephalopathy (EASL 2025) - " The study included 102 patients (age 63, 68% male, 65% Child-Pugh A, 30% on lactulose and/or rifaximin). MHE correlates with larger SPSS, significantly increasing OHE risk despite anti-HE treatment. Nearly all patients developing OHE had large SPSS TCA. Systematic SPSS assessment may be crucial for OHE prevention, potentially more so than MHE screening."

Cardiovascular • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension • CRP

Unveiling the economic burden of decompensated cirrhosis: a comprehensive cost analysis (EASL 2025) - "Cirrhosis acute decompensation imposes significant healthcare costs, especially ICU care, procedures, and albumin and rifaximin use. Mortality and readmission rates remain alarmingly high, underscoring the need for sustained post-discharge care strategies and early intervention, to optimize care and mitigate additional healthcare expenditure."

Cost-analysis • HEOR • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation • Metabolic Dysfunction-Associated Steatotic Liver Disease

ANT at discharge can predicts further development of overt hepatic encephalopathy after elective TIPS placement (EASL 2025) - " 88 consecutive patients were included (men 81.8%, age 60 years, cause of cirrhosis MASH/ALD/MetALD/other in 15/41/24/20 %, MELD score 11.8, Child-Pugh B/C in 76/6%, TIPS indication ascites/secondary prophylaxis/pre surgery in 62/19/14%, previous OHE in 21.6%, lactulose in 35.2%, rifaximin in 69.3%). We confirmed that pre-TIPS ANT was not predictive of further OHE in our series of patients treated with elective TIPS. However, ANT at discharge may be useful to early identify patients at higher risk of OHE after TIPS, in whom prophylaxis could be intensified and liver transplantation discussed."

CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Metabolic Dysfunction-Associated Steatohepatitis