Glucocorticoids in alcoholic hepatitis

Prednisolone (a one-month course of 40 mg a day) appears to decrease mortality in patients with severe alcoholic hepatitis.

A systematic review including 13 studies with a total of 659 subjects was abstracted in DARE. The pooled relative risk of death was 0.62 (95% CI 0.38 to 1.05). The results are suggestive of a publication bias; studies with a high weight (larger sample size) showing no therapeutic effect and those with a low weight showing an effect. There was heterogeneity between trials.

Another systematic review including 3 high quality randomized, placebo-controlled trials found that corticosteroids improved survival at 28 days in patients with severe alcoholic hepatitis (84.6% vs 65.1%, p=0.001).

Comment: The quality of evidence is downgraded by possibility of reporting bias.

The following decision support rules contain links to this evidence summary:

• Glucocorticoids in alcoholic hepatitis

Ədəbiyyat

1. Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut 1995 Jul;37(1):113-8.
2. Mathurin P, Mendenhall CL, Carithers RL Jr, Ramond MJ, Maddrey WC, Garstide P, Rueff B, Naveau S, Chaput JC, Poynard T. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. J Hepatol 2002 Apr;36(4):480-7.