Glucocorticosteroids for people with alcoholic hepatitis

Abstract

Background Alcoholic hepatitis is a form of alcoholic liver disease characterised by steatosis, necroinflammation, fibrosis, and complications to the liver. Typically, alcoholic hepatitis presents in people between 40 and 50 years of age. Alcoholic hepatitis can be resolved if people abstain from drinking, but the risk of death will depend on the severity of the liver damage and abstinence from alcohol. Glucocorticosteroids have been studied extensively in randomised clinical trials to assess their benefits and harms. However, the results have been contradictory. Objectives To assess the benefits and harms of glucocorticosteroids in people with alcoholic hepatitis. Search methods We identified trials through electronic searches in Cochrane Hepato-Biliary's (CHB) Controlled Trials Register, CENTRAL, MED-LINE, Embase, LILACS, and Science Citation Index Expanded. We looked for ongoing or unpublished trials in clinical trials registers and pharmaceutical company sources. We also scanned reference lists of the studies retrieved. The last search was 18 January 2019. Selection criteria Randomised clinical trials assessing glucocorticosteroids versus placebo or no intervention in people with alcoholic hepatitis, irrespective of year, language of publication, or format. We considered trials with adults diagnosed with alcoholic hepatitis, which could have been established through clinical or biochemical diagnostic criteria or both. We defined alcoholic hepatitis as mild (Maddrey's score less than 32) and severe (Maddrey's score 32 or more). We allowed cointerventions in the trial groups, provided they were similar.

RETRACTED: microRNA-155 Modulates Hepatic Stellate Cell Proliferation, Apoptosis, and Cell Cycle Progression in Rats With Alcoholic Hepatitis via the MAPK Signaling Pathway Through Targeting SOCS1

“…AH is one of the most severe alcohol-related liver diseases and is characterized by necroinflammation, fibrosis, steatosis, cirrhosis, and serious compromise of liver function (Pavlov et al, 2019).…”

Diagnosis and Treatment of Alcohol‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases

“…(160) Further complicating the interpretation of studies and the design of future trials is the declining mortality of severe AH over time, ranging from 30%-50% at 28 days in early trials compared with 14%-18% more recently, while several meta-analyses have yielded conflicting conclusions. (161)(162)(163)(164) Mathurin et al combined the individual patient data sets of three, five, then recently 11 RCTs, which ultimately included 2,111 patients. In the latest iteration, corticosteroid treatment significantly reduced mortality at 28 days compared with placebo (hazard ratio, 0.64; 95% CI, 0.48-0.86), representing a 36% risk reduction.…”

Emerging Noninvasive Biomarkers, and Medical Management Strategies for Alcoholic Hepatitis: Present Understanding and Scope

“…The largest trial performed (the STeroids Or Pentoxifylline for Alcoholic Hepatitis [STOPAH] study) showed only a trend for mortality benefit at 28 days with prednisolone, compared with patients receiving placebo (13.8% vs. 18%, p = 0.056) [140]. Recently, a meta-analysis examining 15 trials and greater than 1800 patients found weak evidence for no difference in all-cause mortality and serious adverse events between groups of corticosteroid therapy vs. placebo/no therapy [141]. Major limitations to the use of corticosteroids are patient with infections, poorly controlled diabetes mellitus, renal failure, and active gastrointestinal bleeding [142].…”