Evidence on the impact of treatment optimization on the safety of patients with liver cirrhosis.

OBJECTIVE: To evaluate the impact of therapy optimization on medication-related safety in patients with liver cirrhosis. METHOD: Systematic review of clinical trials and before-and-after studies with time series analysis in CENTRAL, MEDLINE, and INAHTA databases. The certainty of the evidence was assessed using the GRADE approach, and the risk of bias was evaluated with the ROBUST-RCT tool. RESULTS: Six articles were identified, all corresponding to a single randomized controlled trial (116 patients) that evaluated the effectiveness of a pharmacist-led intervention (medication reconciliation and individualized health education) compared to usual care. Although no significant differences were found in all-cause mortality or the crude relative risk of hospitalization, the adjusted incidence rate analysis revealed that the intervention significantly reduced unplanned hospitalizations by 48%. Furthermore, within the intervention group, each unit increase in the rate of high-risk medication-related problems was associated with more than three-fold higher odds of mortality, independently of disease severity. CONCLUSIONS: There is a current scarcity of high-quality studies in this field. Nevertheless, the available evidence suggests that pharmaceutical follow-up is an effective strategy to reduce preventable hospitalizations in outpatients with decompensated cirrhosis. Pharmacological safety is vital for survival, justifying the integration of the pharmacist into the clinical team.