TABLE 2.
Characteristics of the studies comparing carvedilol vs propranolol
| References | Comparison (intervention and time of outcome assessment) | Patient characteristics | Child-Pugh Class (A/B/C)/ Score | NSBB Titration method | Mean NSBB dose (mean±SD; range) | Etiology | Initial number of patients | Number of patients for each comparison | HVPG measurement technique |
|---|---|---|---|---|---|---|---|---|---|
| Bañares29 | Carvedilol (p.o.) vs Propranolol (i.v.) vs Placebo 1 h of administration |
All esophageal varices 62% previous variceal bleed |
13/15/7 | Carvedilol 25 mg Propranolol (0.15 mg/kg intravenously, followed by a continuous infusion of 0.2 mg/kg) |
NR | 57% alcohol 43% Nonalcohol |
35 (14 vs. 14 vs. 7) | 14 vs. 14 vs. 7 | Balloon catheter |
| De38 | Carvedilol (p.o.) vs Propranolol (p.o.). 90 minutes and 7 d Only 7 d comparison used |
Esophageal varices with no previous bleeds, or who had bleeding 7-10 d prior to inclusion. | 5/22/9 Mean: 8.6±1.8 |
Acute study: 80 mg propranolol and 25 mg carvedilol. 7-day study: propranolol 40 mg twice daily and carvedilol 6.25 mg twice daily | NA | 42% alcohol 39% viral |
36 (18 vs. 18) | 18 vs. 18 | Balloon catheter |
| Bañares15 | Carvedilol vs Propranolol (p.o.) 11.1 +/- 4.1 wk |
Esophageal varices without previous bleed | Carvedilol (13/10/3) Propranolol (15/6/4) |
Propranolol started at 10 mg twice daily and Carvedilol at 6.25 mg once daily. Both drugs increased every 4 d until heart rate reduced by 25% or to less than 55 provided that systolic pressure was greater than 85 mm Hg | Propranolol 73 +/- 10 mg/d (range, 10–160) Carvedilol 31 +/- 4 mg/d (range,12.5–50) |
29% alcohol 67% viral 4% others |
51 (26 vs. 25) | 24 vs. 22 | Balloon catheter |
| Hobolth39 | Carvedilol (p.o.) vs. Propranolol (p.o.) 3 mo |
Patients with clinical and endoscopic signs of portal hypertension. | 5/16/8 | Carvedilol started at 3.125 mg BID and Propranolol 40 mg BID. Titrated weekly, to a 25% HR reduction, with HR> 55 and SBP> 90 Max dose Carvedilol: 25 mg/day; Propranolol 320 mg/day |
Carvedilol:14 ± 7 mg Propranolol: 122 ± 64 mg |
NR | 33 (18 vs. 15) | 16 vs. 13 | NR |
| Kim40 | Carvedilol vs Propranolol (p.o.). 6 wk |
All Esophageal varices |
Median: 7 |
Carvedilol 6.25 mg daily and propranolol 20 mg twice daily Carvedilol increased to 12.5 mg and propranolol to 320 mg until HR decreased > 25% from baseline or to 55, with SBP > 90 mm Hg |
Carvedilol Median (IQR): 12.5 (12.5–12.5) mg/day Propranolol Median (IQR): 160 (80–175) mg/day |
61% alcohol 35% viral 4% others |
110 (55 vs. 55) | 47 vs. 43 | Balloon catheter |
| Gupta41 | Carvedilol vs Propranolol 4 wk |
All esophageal varices with the first episode of variceal bleed | 14/39/6 | Carvedilol initial dose 3.125 mg BID, increased up to a dose of 25 mg/day to achieve a target HR 55-60 Propranolol initial dose 40 mg OD, increased to achieve HR between 55-60, or maximum dose of 320 mg/day |
Carvedilol Median: 6.25 (6.25–12.5) mg/day Propranolol Median: 40 (40–80) mg/day |
47% alcohol 29% viral 7% MASLD 2% AIH 15% cryptogenic |
59 (30 vs. 29) | 29 vs. 28 | NR |
Abbreviations: AIH, autoimmune hepatitis; BID, twice daily; IQR, interquartile range; MASLD, metabolic-associated steatotic liver disease; NA, not applicable; NR, not reported; NSBB, nonselective beta-blockers; OD, once daily.