Could Corticosteroid Treatment Reduce Mortality in Alcoholic Hepatitis?

Corticosteroid treatment is associated with a short-term reduced risk of death among individuals with severe alcoholic hepatitis, according to new research. However, use of corticosteroids did not affect long-term mortality risk.

These findings emerged from a meta-analysis of 11 studies (N = 2111) that evaluated various pharmacological therapies for severe alcoholic hepatitis.
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Specifically, meta-analyses were performed for the effects of corticosteroids vs placebo or control, corticosteroids vs pentoxifylline, corticosteroids and pentoxifylline vs corticosteroids and placebo or control, and pentoxifylline vs placebo.

A Cox proportional hazards regression model was used to estimate the effect of treatment on overall survival at 28 days, which was the primary outcome.

Results of the analysis indicated that corticosteroid treatment was associated with a significantly lower risk of death within 28 days compared with controls (hazard ratio [HR] 0.64) or pentoxifylline (HR 0.64).

Furthermore, corticosteroid treatment was found to be significantly associated with increased response to therapy compared with controls (relative risk [RR] 1.24) or pentoxifylline (RR 1.43).

However, no significant differences in 6-month mortality were observed for any treatments compared with controls.

The researchers noted that no difference in 28-day mortality was observed for pentoxifylline-treated patients compared with controls, nor was any difference in 28-day mortality observed for patients treated with a combination of corticosteroids and pentoxifylline vs corticosteroids alone.

“In a meta-analysis of 4 controlled trials, we found corticosteroid use to reduce risk of death within 28 days of treatment, but not in the following 6 months,” the researchers concluded. “This loss of efficacy over time indicates a need for new therapeutic strategies to improve medium-term outcomes.”

—Christina Vogt

Reference:

Louvet A, Thursz MR, Kim DJ, et al. Corticosteroids reduce risk of death within 28 days for patients with severe alcoholic hepatitis, compared with pentoxifylline or placebo—a meta-analysis of individual data [Published online May 5, 2018]. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.05.011

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