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alcoholic hepatitis: goodbye trental

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By Jason Mann No BS pulmonary critical care fellow
Mark R Thursz, Paul Richardson, Michael Allison, Andrew Austin, Megan Bowers, Christopher P Day, Nichola Downs, Dermot Gleeson, Alastair MacGilchrist, Allister Grant, Steven Hood, Steven Masson, Anne McCune, Jane Mellor, John O'Grady, David Patch, Ian Ratcliffe, Paul Roderick, Louise Stanton, Nikhil Vergis, Mark Wright, Stephen Ryder, Ewan H Forrest
BACKGROUND: 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...
April 23, 2015: New England Journal of Medicine
Ashwani K Singal, Patrick S Kamath, Gregory J Gores, Vijay H Shah
Alcoholic hepatitis is a distinct clinical syndrome among people with chronic and active alcohol abuse, with a potential for 30%-40% mortality at 1 month among those with severe disease. Corticosteroids or pentoxifylline are the current pharmacologic treatment options, but they provide only about 50% survival benefit. These agents are recommended for patients with modified discriminant function (mDF) ≥ 32 or Model for End-Stage Liver Disease score ≥ 18. The Lille score is used to determine response to steroids...
April 2014: Clinical Gastroenterology and Hepatology
Ewan Forrest, Jane Mellor, Louise Stanton, Megan Bowers, Priscilla Ryder, Andrew Austin, Christopher Day, Dermot Gleeson, John O'Grady, Steven Masson, Anne McCune, David Patch, Paul Richardson, Paul Roderick, Stephen Ryder, Mark Wright, Mark Thursz
BACKGROUND: Alcoholic hepatitis is the most florid presentation of alcohol-related liver disease. In its severe form, defined by a Maddrey's discriminant function (DF) ≥32, the 28-day mortality rate is approximately 35%. A number of potential treatments have been subjected to clinical trials, of which two, corticosteroids and pentoxifylline, may have therapeutic benefit. The role of corticosteroids is controversial as trial results have been inconsistent, whereas the role of pentoxifylline requires confirmation as only one previous placebo-controlled trial has been published...
August 19, 2013: Trials
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