A Cochrane review included 5 studies with a total of 336 subjects. Pentoxifylline reduced mortality compared with control (RR 0.64, 95% CI 0.46 to 0.89; 5 studies, n= 336). However, this result was not supported by trial sequential analysis, which adjusts for multiple testing on accumulating data. Meta-analysis showed that pentoxifylline reduced the hepatic-related mortality due to hepatorenal syndrome (RR 0.40, 95% CI 0.22 to 0.71; 3 studies, n=182), but trial sequential analysis did not support this result. Data from one trial suggests that pentoxifylline may increase the occurrence of serious and non-serious adverse events compared to control.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and inadequate intention-to-treat adherence) and by indirectness (short-term follow-up; in most studies only 1 month).