Dual therapy a feasible treatment option for severe alcoholic hepatitis
Dual therapy with corticosteroid and pentoxifylline is as good as corticosteroid monotherapy at reducing mortality risk reduction in severe alcoholic hepatitis, but shows superiority in terms of reducing hepatorenal syndrome or acute kidney injury incidence and infection risk, according to a meta-analysis of 25 studies.
The analysis involved a total of 2,639 severe alcoholic hepatitis patients from studies evaluating the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination. Researchers applied the Cochrane methodology to determine the optimal treatment for the disease.
Overall mortality was comparable between the treatment arms.
Corticosteroid monotherapy, but not pentoxifylline monotherapy, was associated with a 42 percent decrease in the risk of 1-month mortality compared with placebo (odds ratio [OR], 0.58; 95 percent CI, 0.34 to 0.98; p=0.04).
Dual therapy and corticosteroid monotherapy showed comparable effects on mortality (OR, 0.91; 0.62 to 1.34; p=0.63).
However, dual therapy significantly reduced the incidences of hepatorenal syndrome or acute kidney injury (OR, 0.47; 0.26 to 0.86; p=0.01), as well as the risk of infection (OR, 0.63; 0.41 to 0.97; p=0.04) compared with corticosteroid monotherapy.
None of the treatments conferred survival benefits in either the medium or long term.
Alcoholic hepatitis is characterised by jaundice and liver impairment, and patients with severe alcoholic hepatitis have a short-term mortality of about 40 to 50 percent. In this group of patients, the treatment of choice is corticosteroids. For patients with contraindications to steroids, pentoxifylline is the second option. [World J Hepatol 2011;3:205–210]
The findings suggest that pentoxifylline may be used together with corticosteroid, producing an effect on mortality that is similar to that of corticosteroid monotherapy. In addition, the hepatorenal syndrome or acute kidney injury-incidence lowering benefit indicates the potential of dual therapy for treating severe alcoholic hepatitis.