Combination Therapy in Severe Alcoholic Hepatitis-Doesn't Really Work

Duseja, Ajay

doi:10.1016/j.jceh.2013.11.005

Journal of Clinical and Experimental Hepatology

2013

DOI: 10.1016/j.jceh.2013.11.005

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Combination Therapy in Severe Alcoholic Hepatitis-Doesn't Really Work

Ajay Duseja

Abstract: Mathurin P, Louvet A, Duhamel A, Nahon P, Carbonell N, Boursier J, Anty R, Diaz E, Thabut D, Moirand R, Lebrec D, Moreno C, Talbodec N, Paupard T, Naveau S, Silvain C, Pageaux GP, Sobesky R, Canva-Delcambre V, Dharancy S, Salleron J, Dao T. Prednisolone with vs without pentoxifylline and survival of patients with severe alcoholic hepatitis: a randomized clinical trial. JAMA.

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“…6 Little benefit has been shown by combining steroids with drugs such as pentoxifylline. 7 Moreover, limited options are available for steroid nonresponsive and steroid ineligible patients (upper gastrointestinal bleed, impaired renal functions, and/or sepsis). Given the progressive nature with high mortality and limited therapeutic options, there is an urgent need for exploring new therapeutic interventions for SAH patients.…”

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Insights into the Role of Granulocyte Colony-Stimulating Factor in Severe Alcoholic Hepatitis

2021

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Alcohol use disorder is the predominant cause of chronic liver disease globally. The standard of care for the treatment of alcoholic hepatitis, corticosteroids, has been shown to provide a therapeutic response in ∼60% of carefully selected patients with a short-term survival benefit. The patients who do not respond to steroids, or are ineligible due to infections or very severe disease, have little options other than liver transplantation. There is, thus, a large unmet need for new therapeutic strategies for this large and sick group of patients. Granulocyte colony stimulating factor (G-CSF) has been shown to favorably modulate the intrahepatic immune milieu and stimulate the regenerative potential of the liver. Initial studies have shown encouraging results with G-CSF in patients with severe alcoholic hepatitis. It has also been found to help steroid nonresponsive patients. There is, however, a need for careful selection of patients, regular dose monitoring and close observation for adverse events of G-CSF. In this review, we analyze the basis of the potential benefits, clinical studies, cautions and challenges in the use of G-CSF in alcoholic hepatitis.

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Insights into the Role of Granulocyte Colony-Stimulating Factor in Severe Alcoholic Hepatitis

2021

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New treatment options for alcoholic hepatitis

Shasthry¹,

Sarin²

2016

WJG

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The burden of alcoholic liver disease has rapidly grown in the past two decades and is expected to increase further in the coming years. Alcoholic hepatitis, the most florid presentation of alcoholic liver disease, continues to have high morbidity and mortality, with significant financial and healthcare burden with limited treatment options. Steroids remain the current standard of care in severe alcoholic hepatitis in carefully selected patients. No specific treatments are available for those patients who are steroid ineligible, intolerant or unresponsive. Liver transplant has shown good short-term outcome; however, feasibility, ethical and economic concerns remain. Modification of gut microbiota composition and their products, such as lipopolysaccharide, nutritional interventions, immune modulation, increasing steroid sensitivity, genetic polymorphism and epigenetic modification of alcohol induced liver damage, augmenting hepatic regeneration using GCSF are potential therapeutic avenues in steroid non-responsive/ineligible patients. With better understanding of the pathophysiology, using "Omics" platforms, newer options for patients with alcoholic hepatitis are expected soon.

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Combination Therapy in Severe Alcoholic Hepatitis-Doesn't Really Work

Cited by 2 publications

References 9 publications

Insights into the Role of Granulocyte Colony-Stimulating Factor in Severe Alcoholic Hepatitis

Insights into the Role of Granulocyte Colony-Stimulating Factor in Severe Alcoholic Hepatitis

New treatment options for alcoholic hepatitis

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