Background:Alcoholic hepatitis is a chronic, inflammatory liver disease that is on the rise in the United States. Traditionally, the progression of severe alcoholic hepatitis has been slowed with a 28-day course of prednisolone. However, since corticosteroids such as prednisolone have been associated with increased risk of infection and multiple unpleasant side effects, newer research is aimed at using pentoxifylline (PTX) as an alternative treatment. PTX has been shown to have a better safety profile than prednisolone, but its effectiveness in the treatment of severe alcoholic hepatitis is in question. Therefore, the aim of this systematic review is to further evaluate the efficacy of PTX as compared to prednisolone in the treatment of severe alcoholic hepatitis in adult patients.Methods:An exhaustive search using MEDLINE-Ovid, MEDLINE-Pub-Med, Web of Science, and Up-To-Date was performed using the terms: pentoxifylline, corticosteroids, and alcoholic hepatitis. Animal studies, articles published over ten years ago, and articles written in non-English languages were excluded from the search. Only randomized-controlled trials were considered for review. All articles were assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.Results:Three studies met criteria and were used in this systematic review. The STOPAH trial, an RCT by Thursz et al found that PTX is less effective than Prednisolone at treating severe alcoholic hepatitis in adults in the prevention of mortality at 28 days (P u3c 0.06). In a small, RCT by Park et al, it was found that PTX is not inferior nor superior to prednisolone in the treatment of severe alcoholic hepatitis. A third RCT by De et al indicated that PTX was superior to prednisolone in the regards to survival at 3 months (Pu3c0.05).Conclusion:The overall quality of evidence supporting the use of PTX rather than prednisolone in the treatment of severe alcoholic hepatitis in adult patients is low. Although there is indication that PTX may be a safer alternative or perhaps equivalent to prednisolone in select patients, there is a lack of evidence from good RCTs to support this theory. Based on the results discussed in this systematic review, further investigation with larger, longer RCTs is warranted.
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机译：背景：酒精性肝炎是一种慢性炎症性肝病，在美国呈上升趋势。传统上，泼尼松龙的28天疗程可延缓严重酒精性肝炎的进展。但是，由于皮质类固醇（如泼尼松龙）与感染风险增加和多种不良副作用有关，因此较新的研究旨在使用己酮可可碱（PTX）作为替代疗法。已显示PTX具有比泼尼松龙更好的安全性，但其在治疗严重酒精性肝炎中的有效性尚有疑问。因此，本系统综述的目的是进一步评估与泼尼松龙相比，PTX在成人严重酒精性肝炎中的疗效。方法：使用MEDLINE-Ovid，MEDLINE-Pub-Med，Web of Science进行详尽搜索，并使用以下术语进行最新信息：己酮可可碱，皮质类固醇和酒精性肝炎。动物研究，十年前发表的文章以及以非英语撰写的文章均被排除在搜索范围之外。仅考虑随机对照试验进行审查。使用推荐，评价，发展和评估等级（GRADE）标准对所有文章进行质量评估。结果：三项研究符合标准，并在本系统评价中使用。 Thursz等人的一项RCT STOPAH试验发现，在预防成人28天死亡率方面，PTX在治疗成人严重酒精性肝炎方面不如泼尼松龙有效（P u3c 0.06）。在Park等人的小型RCT中，发现在严重的酒精性肝炎的治疗中，PTX既不劣于强的松龙，也不优于强的松龙。 De等人的第三个RCT表明，PTX在3个月生存率方面优于泼尼松龙（P u3c0.05）。结论：支持使用PTX而非泼尼松龙治疗重症患者的整体证据质量成年患者酒精性肝炎的发生率很低。尽管有迹象表明在某些患者中PTX可能是泼尼松龙的更安全替代品，或等效于泼尼松龙，但尚无良好的RCT证据支持这一理论。根据本系统评价中讨论的结果，有必要对更大，更长的RCT进行进一步研究。
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