{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:42:06Z","timestamp":1790073726413,"version":"4.0.1"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T00:00:00Z","timestamp":1702857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["EC08\/00087"],"award-info":[{"award-number":["EC08\/00087"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI10\/01552"],"award-info":[{"award-number":["PI10\/01552"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI13\/02535"],"award-info":[{"award-number":["PI13\/02535"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PS09\/00485"],"award-info":[{"award-number":["PS09\/00485"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Non\u2010selective \u03b2\u2010blockers (NSBBs) and endoscopic variceal\u2010ligation (EVL) have similar efficacy preventing first variceal bleeding. Compensated and decompensated cirrhosis are markedly different stages, which may impact treatment outcomes. We aimed to assess the efficacy of NSBBs vs EVL on survival in patients with high\u2010risk varices without previous bleeding, stratifying risk according to compensated\/decompensated stage of cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>By systematic review, we identified RCTs comparing NSBBs vs EVL, in monotherapy or combined, for primary bleeding prevention. We performed a competing\u2010risk, time\u2010to\u2010event meta\u2010analysis, using individual patient data (IPD) obtained from principal investigators of RCTs. Analyses were stratified according to previous decompensation of cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 25 RCTs eligible, 14 failed to provide IPD and 11 were included, comprising 1400 patients (656 compensated, 744 decompensated), treated with NSBBs (<jats:italic>N<\/jats:italic>\u2009=\u2009625), EVL (<jats:italic>N<\/jats:italic>\u2009=\u2009546) or NSBB+EVL (<jats:italic>N<\/jats:italic>\u2009=\u2009229). Baseline characteristics were similar between groups. Overall, mortality risk was similar with EVL vs. NSBBs (subdistribution hazard\u2010ratio (sHR)\u2009=\u20091.05, 95% CI\u2009=\u20090.75\u20131.49) and with EVL\u2009+\u2009NSBBs vs either monotherapy, with low heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200928.7%). In compensated patients, mortality risk was higher with EVL vs NSBBs (sHR\u2009=\u20091.76, 95% CI\u2009=\u20091.11\u20132.77) and not significantly lower with NSBBs+EVL vs NSBBs, without heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%). In decompensated patients, mortality risk was similar with EVL vs. NSBBs and with NSBBs+EVL vs. either monotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with compensated cirrhosis and high\u2010risk varices on primary prophylaxis, NSBBs significantly improved survival vs EVL, with no additional benefit noted adding EVL to NSBBs. In decompensated patients, survival was similar with both therapies. The study suggests that NSBBs are preferable when advising preventive therapy in compensated patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17824","type":"journal-article","created":{"date-parts":[[2023,12,18]],"date-time":"2023-12-18T15:04:01Z","timestamp":1702911841000},"page":"306-321","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Improving primary prophylaxis of variceal bleeding by adapting therapy to the clinical stage of cirrhosis. A competing\u2010risk meta\u2010analysis of individual participant data"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3674-914X","authenticated-orcid":false,"given":"C\u00e0ndid","family":"Villanueva","sequence":"first","affiliation":[{"name":"Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Sapena","sequence":"additional","affiliation":[{"name":"Biostatistics Unit Medical School, Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"},{"name":"Medical Statistics Core Facility IDIBAPS, Hospital Clinic  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-200X","authenticated-orcid":false,"given":"Gin\u2010Ho","family":"Lo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine E\u2010Da Hospital, I\u2010Shou University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Seok","family":"Seo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Korea University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasnain Ali","family":"Shah","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9113-5167","authenticated-orcid":false,"given":"Virendra","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Hepatology Post Graduate Institute of Medical Education and Research  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9043-6382","authenticated-orcid":false,"given":"Dhiraj","family":"Tripathi","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust  Birmingham UK"},{"name":"Institute of Immunology and Immunotherapy University of Birmingham  Birmingham UK"},{"name":"Department of Hepatology Royal Infirmary of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schepke","sequence":"additional","affiliation":[{"name":"Helios Clinic Siegburg Department Gastroenterology and Hepatology  Siegburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Gheorghe","sequence":"additional","affiliation":[{"name":"Center of Gastroenterology &amp; Hepatology, Fundeni Clinical Institute \"Carol Davila\" University of Medicine  Bucharest Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniell Q.","family":"Bonilha","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Federal University of S\u00e3o Paulo, State University of Campinas  Campinas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rome","family":"Jutabha","sequence":"additional","affiliation":[{"name":"University of Southern California (USC) School of Medicine  Los Angeles USA"},{"name":"Keck School of Medicine of University of Southern California and Clinical Outreach and Development  Los Angeles USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huay\u2010Min","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital  Kaohsiung Taiwan, Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana G.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"University Clinic for Visceral Surgery and Medicine, Inselspital Bern University Hospital  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Brujats","sequence":"additional","affiliation":[{"name":"Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Aut\u00f2noma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0430-1607","authenticated-orcid":false,"given":"Han Ah.","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Korea University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahid","family":"Azam","sequence":"additional","affiliation":[{"name":"National Institute of Liver &amp; 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