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Cited 13 time in webofscience Cited 10 time in scopus
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Treatment of Severe Alcoholic Hepatitis With Corticosteroid, Pentoxifylline, or Dual Therapy A Systematic Review and Meta-Analysis

Authors
Lee, Young-SunKim, Hyun JungKim, Ji HoonYoo, Yang JaeKim, Tae SukKang, Seong HeeSuh, Sang JunJoo, Moon KyungJung, Young KulLee, Beom JaeSeo, Yeon SeokYim, Hyung JoonYeon, Jong EunKim, Jae SeonPark, Jong-JaeUm, Soon HoBak, Young-TaeByun, Kwan Soo
Issue Date
Apr-2017
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
corticosteroid; pentoxifylline; severe alcoholic hepatitis
Citation
Journal of Clinical Gastroenterology, v.51, no.4, pp.364 - 377
Indexed
SCIE
SCOPUS
Journal Title
Journal of Clinical Gastroenterology
Volume
51
Number
4
Start Page
364
End Page
377
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/5136
DOI
10.1097/MCG.0000000000000674
ISSN
0192-0790
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.
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Kim, Jae Seon
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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