Where Are We with Pentoxifylline for Severe Alcoholic Hepatitis?

A pooled analysis of available trial data showed a 53% reduction in mortality from hepatorenal syndrome, but no reduction in overall mortality, compared with placebo.

Acute alcoholic hepatitis (AH) is associated with high rates of morbidity and mortality. The commonly recommended treatment is corticosteroids, which have been shown to improve short-term survival but have substantial adverse effects, such as infection and sepsis. Pentoxifylline (PTX), an oral anti–tumor necrosis factor agent, has also been used in reducing hepatorenal syndrome (HRS) and mortality in AH and is recommended when infection precludes corticosteroid use. However, evidence of its efficacy is based on only a small number of studies. The current systematic review incorporates the largest number of trials to date evaluating the efficacy of PTX in severe AH.

Investigators identified abstracts and articles of randomized, controlled trials of PTX in patients with AH. Outcomes were 28-day and 6-month mortality and incidence of HRS. Relative risks were calculated for pooled data using random effects modeling.

A total of 884 patients with severe AH from 10 studies (4 abstracts and 6 articles) were included in the analysis. Pooled data from trials examining mortality outcomes demonstrated a reduction in fatal HRS with PTX compared with placebo (RR, 0.47; 95% confidence interval, 0.26–0.86), but no improvement in overall mortality at 1 month (RR, 0.58; 95% CI, 0.31–1.07). Compared with corticosteroids, neither PTX nor a combination of PTX and corticosteroids reduced mortality or HRS incidence. Researchers found significant heterogeneity between trials regarding control groups and trial endpoints.

CITATION(S):

Parker R et al. Systematic review: Pentoxifylline for the treatment of severe alcoholic hepatitis. Aliment Pharmacol Ther 2013 May; 37:845.