Show simple item record

dc.contributor.authorAustin, Andrew
dc.date.accessioned2018-01-24T17:18:43Z
dc.date.available2018-01-24T17:18:43Z
dc.date.issued2015-04
dc.identifier.citationThe New England Journal of Medicine; Apr 2015; vol. 372 (no. 17); p. 1619-1628en
dc.identifier.urihttp://hdl.handle.net/20.500.12904/488
dc.description.abstractBackground: Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use. The short-term mortality among patients with severe disease exceeds 30%. Prednisolone and pentoxifylline are both recommended for the treatment of severe alcoholic hepatitis, but uncertainty about their benefit persists. Methods: We conducted a multicenter, double-blind, randomized trial with a 2-by-2 factorial design to evaluate the effect of treatment with prednisolone or pentoxifylline. The primary end point was mortality at 28 days. Secondary end points included death or liver transplantation at 90 days and at 1 year. Patients with a clinical diagnosis of alcoholic hepatitis and severe disease were randomly assigned to one of four groups: a group that received a pentoxifylline-matched placebo and a prednisolone-matched placebo, a group that received prednisolone and a pentoxifylline-matched placebo, a group that received pentoxifylline and a prednisolone-matched placebo, or a group that received both prednisolone and pentoxifylline. Results: A total of 1103 patients underwent randomization, and data from 1053 were available for the primary end-point analysis. Mortality at 28 days was 17% (45 of 269 patients) in the placebo–placebo group, 14% (38 of 266 patients) in the prednisolone–placebo group, 19% (50 of 258 patients) in the pentoxifylline–placebo group, and 13% (35 of 260 patients) in the prednisolone–pentoxifylline group. The odds ratio for 28-day mortality with pentoxifylline was 1.07 (95% confidence interval [CI], 0.77 to 1.49; P = 0.69), and that with prednisolone was 0.72 (95% CI, 0.52 to 1.01; P = 0.06). At 90 days and at 1 year, there were no significant between-group differences. Serious infections occurred in 13% of the patients treated with prednisolone versus 7% of those who did not receive prednisolone (P = 0.002). Conclusions: Pentoxifylline did not improve survival in patients with alcoholic hepatitis. Prednisolone was associated with a reduction in 28-day mortality that did not reach significance and with no improvement in outcomes at 90 days or 1 year.en
dc.language.isoenen
dc.subjectAlcoholic Hepatitisen
dc.subjectPrednisoloneen
dc.subjectPentoxifyllineen
dc.titlePrednisolone or pentoxifylline for alcoholic hepatitisen
dc.typeArticleen
refterms.dateFOA2021-06-03T10:08:53Z


Files in this item

Thumbnail
Name:
(559) NEJM.pdf
Size:
484.6Kb
Format:
PDF

This item appears in the following Collection(s)

Show simple item record