Brief Articles
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World J Gastroenterol. Apr 7, 2009; 15(13): 1613-1619
Published online Apr 7, 2009. doi: 10.3748/wjg.15.1613
Pentoxifylline versus prednisolone for severe alcoholic hepatitis: A randomized controlled trial
Binay Krishna De, Subhabrata Gangopadhyay, Deep Dutta, Sumanta Das Baksi, Adyapad Pani, Pramit Ghosh
Binay Krishna De, Subhabrata Gangopadhyay, Deep Dutta, Sumanta Das Baksi, Adyapad Pani, Pramit Ghosh, Department of Medicine, Medical College & Hospitals, Calcutta, 88 College Street, Calcutta 700073, India
Pramit Ghosh, Department of Preventive and Social Medicine, Medical College & Hospitals, Calcutta, 88 College Street, Calcutta 700073, India
Author contributions: De BK conceptualized the study; De BK and Dutta D designed the research; Gangopadhyay S and Dutta D performed the research; Baksi SD randomized the patients; Pani A administered the drugs to the patients; Dutta D and Ghosh P analyzed the data; De BK and Dutta D wrote the manuscript.
Correspondence to: Binay Krishna De, Department of Medicine, Medical College & Hospitals, Calcutta, 88 College Street, Calcutta 700073, India. binaykde@hotmail.com
Telephone: +91-33-23731060
Fax: +91-33-25740733
Received: October 22, 2008
Revised: February 23, 2009
Accepted: March 2, 2009
Published online: April 7, 2009
Abstract

AIM: To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis, and to evaluate the role of different liver function scores in predicting prognosis.

METHODS: Sixty-eight patients with severe alcoholic hepatitis (Maddrey score ≥ 32) received pentoxifylline (n = 34, group I) or prednisolone (n = 34, group II) for 28 d in a randomized double-blind controlled study, and subsequently in an open study (with a tapering dose of prednisolone) for a total of 3 mo, and were followed up over a period of 12 mo.

RESULTS: Twelve patients in group II died at the end of 3 mo in contrast to five patients in group I. The probability of dying at the end of 3 mo was higher in group II as compared to group I (35.29% vs 14.71%, P = 0.04; log rank test). Six patients in group II developed hepatorenal syndrome as compared to none in group I. Pentoxifylline was associated with a significantly lower model for end-stage liver disease (MELD) score at the end of 28 d of therapy (15.53 ± 3.63 vs 17.78 ± 4.56, P = 0.04). Higher baseline Maddrey score was associated with increased mortality.

CONCLUSION: Reduced mortality, improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.

Keywords: Alcoholic hepatitis; Pentoxifylline; Prednisolone; Maddrey discriminant function score; Model for end-stage liver disease score; Glasgow alcoholic hepatitis score