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 from the United Kingdom summarized evidence for the use of pentoxifylline in severe alcoholic hepatitis.
The team undertook a literature search using MeSH terms ‘hepatitis, alcoholic’ and ‘pentoxifylline’ using the set operator AND.
The researchers 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.
|There was a reduced incidence of fatal hepatorenal syndrome with pentoxifylline|
|Alimentary Pharmacology & Therapeutics|
Risk of bias was assessed using Cochrane group criteria and quality of trials assessed using ‘Consolidated Standards of Reporting Trials’ CONSORT guidelines.
The team identified 10 trials including 884 participants, from 6 papers and 4 abstracts.
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 researchers found a reduced incidence of fatal hepatorenal syndrome with pentoxifylline compared with placebo, but no survival benefit at 1 month.
The team observed no significant differences between treatment groups in trials of pentoxifylline vs. corticosteroid, or vs. combination therapy.
Dr Parker's team concluded, "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."