Treatment of Severe Alcoholic Hepatitis with Corticosteroid, Pentoxifylline, or Dual Therapy

Young-Sun Lee, Hyun Jung Kim, Ji Hoon Kim, Yang Jae Yoo, Tae Suk Kim, Seong Hee Kang, Sang Jun Suh, Moon Kyung Joo, Young Kul Jung, Beomjae Lee, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Jae Seon Kim, Jong Jae Park, Soon-Ho Um, Young Tae Bak, Kwan Soo Byun

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background and Aims: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015. Combinations of the following keywords and controlled vocabularies were searched: alcoholic hepatitis, corticosteroid, and pentoxifylline. Results: A total of 2639 patients from 25 studies were included. The treatment groups did not differ significantly in terms of overall mortality. Analysis of 1-month mortality revealed corticosteroid monotherapy reduced mortality compared with placebo (OR=0.58; 95% CI, 0.34-0.98; P=0.04), but pentoxifylline monotherapy did not. The mortality with dual therapy was similar to corticosteroid monotherapy (OR=0.91; 95% CI, 0.62-1.34; P=0.63). However, dual therapy decreased the incidences of hepatorenal syndrome or acute kidney injury (OR=0.47; 95% CI, 0.26-0.86; P=0.01) and the infection risk (OR=0.63; 95% CI, 0.41-0.97; P=0.04) significantly more than corticosteroid monotherapy did. None of the treatments conferred any medium-term or long-term survival benefits in the present study. Conclusions: Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection. Therefore, dual therapy might be considered in treatment of patients with severe alcoholic hepatitis.

Original languageEnglish
Pages (from-to)364-377
Number of pages14
JournalJournal of Clinical Gastroenterology
Volume51
Issue number4
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Alcoholic Hepatitis
Pentoxifylline
Adrenal Cortex Hormones
Mortality
Hepatorenal Syndrome
Therapeutics
Acute Kidney Injury
Controlled Vocabulary
Incidence
Therapeutic Uses
Infection
MEDLINE
Placebos

Keywords

  • corticosteroid
  • pentoxifylline
  • severe alcoholic hepatitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{4a50ab7a25b34e389d0c8b042b9709b6,
title = "Treatment of Severe Alcoholic Hepatitis with Corticosteroid, Pentoxifylline, or Dual Therapy",
abstract = "Background and Aims: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015. Combinations of the following keywords and controlled vocabularies were searched: alcoholic hepatitis, corticosteroid, and pentoxifylline. Results: A total of 2639 patients from 25 studies were included. The treatment groups did not differ significantly in terms of overall mortality. Analysis of 1-month mortality revealed corticosteroid monotherapy reduced mortality compared with placebo (OR=0.58; 95{\%} CI, 0.34-0.98; P=0.04), but pentoxifylline monotherapy did not. The mortality with dual therapy was similar to corticosteroid monotherapy (OR=0.91; 95{\%} CI, 0.62-1.34; P=0.63). However, dual therapy decreased the incidences of hepatorenal syndrome or acute kidney injury (OR=0.47; 95{\%} CI, 0.26-0.86; P=0.01) and the infection risk (OR=0.63; 95{\%} CI, 0.41-0.97; P=0.04) significantly more than corticosteroid monotherapy did. None of the treatments conferred any medium-term or long-term survival benefits in the present study. Conclusions: Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection. Therefore, dual therapy might be considered in treatment of patients with severe alcoholic hepatitis.",
keywords = "corticosteroid, pentoxifylline, severe alcoholic hepatitis",
author = "Young-Sun Lee and Kim, {Hyun Jung} and Kim, {Ji Hoon} and Yoo, {Yang Jae} and Kim, {Tae Suk} and Kang, {Seong Hee} and Suh, {Sang Jun} and Joo, {Moon Kyung} and Jung, {Young Kul} and Beomjae Lee and Seo, {Yeon Seok} and Yim, {Hyung Joon} and Yeon, {Jong Eun} and Kim, {Jae Seon} and Park, {Jong Jae} and Soon-Ho Um and Bak, {Young Tae} and Byun, {Kwan Soo}",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/MCG.0000000000000674",
language = "English",
volume = "51",
pages = "364--377",
journal = "Journal of Clinical Gastroenterology",
issn = "0192-0790",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Treatment of Severe Alcoholic Hepatitis with Corticosteroid, Pentoxifylline, or Dual Therapy

AU - Lee, Young-Sun

AU - Kim, Hyun Jung

AU - Kim, Ji Hoon

AU - Yoo, Yang Jae

AU - Kim, Tae Suk

AU - Kang, Seong Hee

AU - Suh, Sang Jun

AU - Joo, Moon Kyung

AU - Jung, Young Kul

AU - Lee, Beomjae

AU - Seo, Yeon Seok

AU - Yim, Hyung Joon

AU - Yeon, Jong Eun

AU - Kim, Jae Seon

AU - Park, Jong Jae

AU - Um, Soon-Ho

AU - Bak, Young Tae

AU - Byun, Kwan Soo

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Aims: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015. Combinations of the following keywords and controlled vocabularies were searched: alcoholic hepatitis, corticosteroid, and pentoxifylline. Results: A total of 2639 patients from 25 studies were included. The treatment groups did not differ significantly in terms of overall mortality. Analysis of 1-month mortality revealed corticosteroid monotherapy reduced mortality compared with placebo (OR=0.58; 95% CI, 0.34-0.98; P=0.04), but pentoxifylline monotherapy did not. The mortality with dual therapy was similar to corticosteroid monotherapy (OR=0.91; 95% CI, 0.62-1.34; P=0.63). However, dual therapy decreased the incidences of hepatorenal syndrome or acute kidney injury (OR=0.47; 95% CI, 0.26-0.86; P=0.01) and the infection risk (OR=0.63; 95% CI, 0.41-0.97; P=0.04) significantly more than corticosteroid monotherapy did. None of the treatments conferred any medium-term or long-term survival benefits in the present study. Conclusions: Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection. Therefore, dual therapy might be considered in treatment of patients with severe alcoholic hepatitis.

AB - Background and Aims: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015. Combinations of the following keywords and controlled vocabularies were searched: alcoholic hepatitis, corticosteroid, and pentoxifylline. Results: A total of 2639 patients from 25 studies were included. The treatment groups did not differ significantly in terms of overall mortality. Analysis of 1-month mortality revealed corticosteroid monotherapy reduced mortality compared with placebo (OR=0.58; 95% CI, 0.34-0.98; P=0.04), but pentoxifylline monotherapy did not. The mortality with dual therapy was similar to corticosteroid monotherapy (OR=0.91; 95% CI, 0.62-1.34; P=0.63). However, dual therapy decreased the incidences of hepatorenal syndrome or acute kidney injury (OR=0.47; 95% CI, 0.26-0.86; P=0.01) and the infection risk (OR=0.63; 95% CI, 0.41-0.97; P=0.04) significantly more than corticosteroid monotherapy did. None of the treatments conferred any medium-term or long-term survival benefits in the present study. Conclusions: Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection. Therefore, dual therapy might be considered in treatment of patients with severe alcoholic hepatitis.

KW - corticosteroid

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KW - severe alcoholic hepatitis

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