Optimum prednisolone usage in patients with biliary atresia postportoenterostomy

Randomized, double-blind, placebo-controlled trial of corticosteroids after Kasai portoenterostomy for biliary atresia

“…12,13 Thereafter, small uncontrolled studies suggested a benefit when they were used postoperatively as adjuvant therapy. [2][3][4][5]14 Nonetheless, actual evidence for their efficacy has been difficult to obtain, and to date there has been no attempt to conduct a randomized, placebo-controlled clinical trial.…”

“…13 Early commencement in the first week after the operation appears unpopular and is not recommended. 16 However, little actual evidence has been published, 4,14,16 and certainly no prospective comparison has been published. Kobayashi et al 4 retrospectively reviewed 5 different regimens (including no steroids) in a series of 63 cases from 1 Tokyo center, but they found no difference except in 1, which consisted of an initial daily dose of 20 mg of prednisolone given for a variable period dictated by changes in the stool color.…”

“…Postoperative steroids have been used empirically for many years, with a number of retrospective, uncontrolled reports suggesting a benefit. [2][3][4][5] However, because of its rarity, there has never been any attempt at a randomized, placebo-controlled trial to test their value.…”

Corticosteroid treatment in biliary atresia: Tonic or toast?

“…Thus, there is a reasonable scientific justification for the potential benefits of steroid therapy in BA. The clinical use of steroids in BA has exploded in recent years following the publication of a series of reports [14][15][16][17][18][19][20] attesting to better outcomes with routine post-HPE steroid therapy compared to a variety of historical or concurrent control groups. Each report used a different maximum dose of steroids (1-10 mg/kg/day), had its own unique dose tapering schedule, and was of variable treatment duration (generally 1-3 months).…”

Maximizing Kasai portoenterostomy in the treatment of biliary atresia: Medical and surgical options

“…This is compounded by surgeon and disease variation, leaving only small cohorts to analyse. 25 A meta-analysis failed to find evidence of effect. 26 A randomised placebo-controlled trial from 2 centres in the United Kingdom retrospectively reviewed low-dose prednisolone treatment (starting at 2 mg/kg/day) in 73 infants.…”