Terlipressin (Terlivaz)

Peptide

Terlipressin is a synthetic vasopressin analog with preferential V1 receptor activity used for hepatorenal syndrome and variceal bleeding. FDA-approved September 2022 as the first and only drug for HRS-AKI in the US. CONFIRM trial (n=300): HRS reversal 32% vs 17% placebo (P=0.012). Also highly effective for acute variceal bleeding - Cochrane meta-analysis showed 34% relative reduction in mortality vs placebo. SAFETY CONCERN: Black box warning for respiratory failure risk - avoid if oxygen saturation <90%.

Quick Answer

What it is

Key findings

Grade A: HRS Reversal (CONFIRM Trial) (Hepatorenal Syndrome)
Grade A: HRS Reversal (Pooled Analysis) (Hepatorenal Syndrome)
Grade A: Serum Creatinine Improvement (Hepatorenal Syndrome)

Safety

SAFETY CONCERN: Black box warning for respiratory failure risk - avoid if oxygen saturation <90%.
34% relative risk reduction.
SAFETY CONCERN: CONFIRM trial showed increased serious respiratory adverse events with terlipressin.

⚠️ Research Notice

This peptide information is for educational and research purposes only. Peptides may not be FDA-approved for human use and may only be legally available for research purposes. Consult qualified healthcare professionals before considering any peptide compounds.

ℹ️ Quick Facts: Terlipressin (Terlivaz)

Quick Facts: Terlipressin (Terlivaz)

Best Evidence:Grade A
Conditions Studied:2
Research Outcomes:11
Grade A Findings:6
Grade B Findings:3
Key Effect:Hepatorenal Syndrome

2 conditions · 11 outcomes

Detailed Outcomes

HRS Reversal (CONFIRM Trial)

CONFIRM Phase 3 trial (n=300): Verified HRS reversal achieved in 32% terlipressin vs 17% placebo (P=0.012). Led to FDA approval. Mean serum creatinine improvement significantly greater with terlipressin. Effects maintained through study duration.

large↑Improves

HRS Reversal (Pooled Analysis)

Pooled OT-0401 + REVERSE trials (n=308): HRS reversal 27% terlipressin vs 14% placebo (P=0.004). Mean serum creatinine difference -53.0 umol/L favoring terlipressin (P<0.0001). Consistent effect across both trials.

large↑Improves

Serum Creatinine Improvement

CONFIRM trial: Significant improvement in renal function with terlipressin vs placebo. 29% achieved kidney function improvement vs 16% placebo. Early treatment (<48h from diagnosis) associated with better outcomes.

moderate↑Improves

Respiratory Failure Risk

SAFETY CONCERN: CONFIRM trial showed increased serious respiratory adverse events with terlipressin. Black box warning: Risk of respiratory failure. Avoid use if oxygen saturation <90%. Higher risk in ACLF grade 3 patients. Patients with SCr >5 mg/dL unlikely to benefit.

moderate↑Worsens

Mortality Reduction (Variceal Bleeding)

Cochrane meta-analysis (7 RCTs, 443 patients): Terlipressin reduced all-cause mortality vs placebo (RR 0.66, 95% CI 0.49-0.88). 34% relative risk reduction. The only vasoactive agent proven to reduce mortality in acute variceal hemorrhage.

large↓Improves

Bleeding Control (Variceal)

2018 meta-analysis (30 RCTs, 3344 patients): Terlipressin significantly improved bleeding control within 48h vs no vasoactive drug (OR 2.94, P=0.0008). Reduced need for emergency procedures (RR 0.72 vs placebo).

large↑Improves