Glucocorticosteroids versus placebo or no intervention for patients with alcoholic hepatitis have been evaluated for more than 35 years.
However, the results of randomized trials and meta-analyses differ substantially.
Dr Gluud and colleagues from Denmark reviewed all randomized clinical trials of glucocorticosteroids vs placebo or no intervention for patients with alcoholic hepatitis.
The research team searched for randomized trials published before July 2007.
The trials were assessed for risk of bias.
| The overall mortality rate was 40%|
|Alimentary Pharmacology & Therapeutics|
The researchers included 15 trials with a total of 721 randomized patients.
The overall mortality rate was 40%.
The team reported that 12 of the 15 trials were at risk of bias.
Glucocorticosteroids did not statistically reduce mortality compared with placebo or no intervention.
Glucocorticosteroids significantly reduced mortality in the subgroup of trials with patients with Maddrey's score of at least 32 or hepatic encephalopathy and with low-bias risk.
In all analyses, the team noted that heterogeneity was significant and substantial.
Trial sequential analyses using heterogeneity-adjusted information size demonstrated no significant effect of glucocorticosteroids on mortality.
The team found that after taking prognostic factors at randomization into consideration, there was no significant effect of glucocorticosteroids on mortality.
Dr Gluud's team commented, "The current evidence base of mainly heterogeneous with high bias risk trials does not support the use of glucocorticosteroids in alcoholic hepatitis."
"Large, low-bias risk placebo-controlled randomized trials are needed."