Trial reportHepatology communications2024
The RIVET RCT: Rifamycin SV MMX improves muscle mass, physical function, and ammonia in cirrhosis and minimal encephalopathy.
Trial report in Hepatology communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- [Chinese guidelines for clinical diagnosis, treatment, and management of cirrhosis (2025)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Guideline
- A Systematic Review of Microbiota in Cirrhosis: A Change Towards a More Pathogenic Predisposition.International journal of molecular sciences · 2025Pooled it
- The role of systemic inflammation in hepatic encephalopathy: advances in inflammatory mechanisms, prevention and treatment research.Annals of medicine · 2026Review
- Sarcopenia and Skeletal Muscle Dysfunction in Liver Cirrhosis: Clinical Perspectives of Myostatin Inhibition.Biomedicines · 2026Review
- Editorial: Rifaximin and the Gut-Liver-Brain Axis-Progress and Prudence.Alimentary pharmacology & therapeutics · 2026Article
- Covert hepatic encephalopathy as a multi-organ syndrome: the gut-liver-muscle-brain axis, diagnosis, treatment, and multidisciplinary care.Journal of gastroenterology · 2026Review
- Voluntary wheel running modulates murine gut microbiome during hyperammonemic stress.Microbiology spectrum · 2026Article
- Chinese Guidelines for Clinical Diagnosis, Treatment, and Management of Cirrhosis (2025).Journal of clinical and translational hepatology · 2026Article
- Microbial Approaches to Treat and Prevent Hepatic Encephalopathy.Gastroenterology clinics of North America · 2025Review
- Genome Mining Reveals Rifamycin Biosynthesis in a Taklamakan Desert Actinomycete.Microorganisms · 2025Article
- Rifaximin-α use is associated with improved muscle mass in patients with cirrhosis.World journal of hepatology · 2025Article
- Chinese Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis (2024).Journal of clinical and translational hepatology · 2025Article
- Attenuating hyperammonemia preserves protein synthesis and muscle mass via restoration of perturbed metabolic pathways in bile duct-ligated rats.Metabolic brain disease · 2025Article
- Ammonia-triggered disintegration of kappa-carrageenan hydrogel carrier for site-specific anti-inflammatory drug delivery.Frontiers in bioengineering and biotechnology · 2025Article
- [Chinese guidelines on the management of hepatic encephalopathy in cirrhosis (2024)].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2024Article
- Letter to the Editor: Rifamycin SV MMX was superior to placebo, but was the comparison appropriate?Hepatology communications · 2024Article
- Fecal microbiota transplantation in the treatment of hepatic encephalopathy: A perspective.World journal of hepatology · 2024Article
Corrections and comments
- Commented on by
Authors and funding
14 authors.
Funding
Abstract
backgroundMinimal hepatic encephalopathy (MHE) negatively affects the prognosis of cirrhosis, but treatment is not standard. Rifamycin SV MMX (RiVM) is a nonabsorbable rifampin derivative with colonic action.
methodsIn a phase 2 placebo-controlled, double-blind randomized clinical trial patients with MHE were randomized to RiVM or placebo for 30 days with a 7-day follow-up. The primary endpoint was a change in stool cirrhosis dysbiosis ratio. Gut-brain (cognition, stool/salivary microbiome, ammonia, brain magnetic resonance spectroscopy), inflammation (stool calprotectin/serum cytokines), patient-reported outcomes (sickness impact profile: total/physical/psychosocial, high = worse), and sarcopenia (handgrip, bioelectric impedance) were secondary. Between/within groups and delta (post-pre) comparisons were performed.
resultsThirty patients (15/group) were randomized and completed the study without safety concerns. While cirrhosis dysbiosis ratio was statistically similar on repeated measures ANOVA (95% CI: -0.70 to 3.5), ammonia significantly reduced (95% CI: 4.4-29.6) in RiVM with changes in stool microbial α/β-diversity. MHE status was unchanged but only serial dotting (which tests motor strength) improved in RiVM-assigned patients. Delta physical sickness impact profile (95% CI: 0.33 = 8.5), lean mass (95% CI: -3.3 to -0.9), and handgrip strength (95% CI: -8.1 to -1.0) improved in RiVM versus placebo. Stool short-chain fatty acids (propionate, acetate, and butyrate) increased post-RiVM. Serum, urine, and stool bile acid profile changed to nontoxic bile acids (higher hyocholate/ursodeoxycholate and lower deoxycholate/lithocholate) post-RiVM. Serum IL-1β and stool calprotectin decreased while brain magnetic resonance spectroscopy showed higher glutathione concentrations in RiVM.
conclusionsRiVM is well tolerated in patients with MHE with changes in stool microbial composition and function, ammonia, inflammation, brain oxidative stress, and sarcopenia-related parameters without improvement in cognition. RiVM modulates the gut-brain axis and gut-muscle axis in cirrhosis.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.