Acute alcoholic hepatitis is a severe manifestation of alcoholic liver disease with a grave prognosis.
Pentoxifylline, an oral antitumor necrosis factor agent, has been reported to reduce mortality and incidence of hepatorenal syndrome in severe alcoholic hepatitis.
Dr Parker and colleagues summarized evidence for the use of pentoxifylline in severe alcoholic hepatitis.
The team performd a literature search was undertaken using MeSH terms ‘hepatitis, alcoholic’ and ‘pentoxifylline’ using the set operator AND.
The research team included randomized controlled trials examining pentoxifylline in severe alcoholic hepatitis, published as abstracts or full manuscripts.
Risk ratios were calculated for pooled data using random effects modelling.
The team of doctors examined that the risk of bias was assessed using Cochrane group criteria and quality of trials assessed using ‘Consolidated Standards of Reporting Trials’ CONSORT guidelines.
The team included 10 trials with 884 participants, from 6 papers and 4 abstracts.
|There was a reduced incidence of fatal hepatorenal syndrome with pentoxifylline|
|Alimentary Pharmacology & Therapeutics|
The research team noted that there was significant heterogeneity between trials regarding control groups and trial end-points.
Treatment was given for 28 days in all trials except one.
The doctors examined that the pooling of data showed a reduced incidence of fatal hepatorenal syndrome with pentoxifylline compared with placebo, but no survival benefit at 1 month.
There were no significant differences between treatment groups in trials of pentoxifylline vs. corticosteroid, or vs. combination therapy.
Dr Parker's team commented, "Pentoxifylline appears superior to placebo in prevention of fatal hepatorenal syndrome and thus may be effective treatment of severe alcoholic hepatitis when corticosteroids are contraindicated."
"However, multiple trials have failed to show conclusive superiority of either pentoxifylline or corticosteroids."