A study has revealed that four weeks of treatment with a combination of the drug pentoxifylline and the corticosteroid prednisolone did not improve 6-month survival compared with prednisolone alone in 270 patients with severe alcoholic hepatitis. The study can be found in the September 11 issue of JAMA.
Treatment of severe forms of alcoholic hepatitis is extremely challenging because of the poor outcome. European and U.S. guidelines recommend the use of prednisolone or pentoxifylline in patients with severe alcoholic hepatitis. Nevertheless, a substantial proportion of patients die after 6 months regardless of first-line therapy, according to background information in the article.
Options for Patients Suffering from Severe Alcoholic Hepatitis
Clinical practice in the treatment of patients with severe or acute alcoholic hepatitis will be made clearer by results from two French studies
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Philippe Mathurin, M.D., of the Hopital Hurlez, Lille, France and colleagues compared the efficacy of a combination of prednisolone and pentoxifylline with prednisolone alone in patients with severe alcoholic hepatitis in 1 Belgian and 23 French hospitals. Duration of follow-up was 6 months. They randomly assigned 270 patients (18 to 70 years of age, who were heavy drinkers with severe biopsy-proven alcoholic hepatitis) to receive 40 mg of prednisolone once a day and 400 mg of pentoxifylline 3 times a day (n=133) for 28 days, or 40 mg of prednisolone and matching placebo (n=137) for 28 days, between December 2007 and March 2010
Eighty-two deaths occurred in the 2 groups during the 6-month follow-up, due to complications from liver failure in 67 cases (81.7 percent) and other causes including gastrointestinal bleeding in 15 cases (18.3 percent). The researchers found no difference in 6-month survival between the 2 groups (69.9 percent in the pentoxifylline-prednisolone group [40 deaths] vs. 69.2 percent [in the placebo-prednisolone group [42 deaths]). Response to treatment and the probability of being a responder were also no different between groups.
![N-Acetylcysteine Does Not Improve Survival in Prednisolone-treated Severe Alcoholic Hepatitis]( "N-Acetylcysteine Does Not Improve Survival in Prednisolone-treated Severe Alcoholic Hepatitis")
Results from a recent study indicate that addition of N-acetylcysteine to prednisolone may not improve survival at the end of 6 months in patients with severe alcoholic hepatitis.
The cumulative incidence of hepatorenal syndrome (rapid deterioration in kidney function) at 6 months was also not different in the pentoxifylline-prednisolone and the placebo-prednisolone groups.
Because of the lack of difference in survival and other outcomes, "our study does not support the use of a combination of pentoxifylline and prednisolone for severe alcoholic hepatitis," the authors write, concluding that "future studies with an appropriate design are needed to provide robust data for developing new strategies to improve the outcome of patients with this life-threatening disease."
Source: Newswise
N-Acetylcysteine Does Not Improve Survival in Prednisolone-treated Severe Alcoholic Hepatitis
Results from a recent study indicate that addition of N-acetylcysteine to prednisolone may not improve survival at the end of 6 months in patients with severe alcoholic hepatitis.
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The cumulative incidence of hepatorenal syndrome (rapid deterioration in kidney function) at 6 months was also not different in the pentoxifylline-prednisolone and the placebo-prednisolone groups.
Because of the lack of difference in survival and other outcomes, "our study does not support the use of a combination of pentoxifylline and prednisolone for severe alcoholic hepatitis," the authors write, concluding that "future studies with an appropriate design are needed to provide robust data for developing new strategies to improve the outcome of patients with this life-threatening disease."
Source: Newswise
Early Liver Transplantation Improves Survival in Alcoholics With Severe Hepatitis
Recent research suggests that early Liver Transplantation Improves Survival in Individuals with Severe Alcoholic Hepatitis.
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