Systematic review: pentoxifylline for the treatment of severe alcoholic hepatitis. Issue 9 (13th March 2013)

• Record Type: Journal Article
• Authors: Parker, R.; Armstrong, M. J.; Corbett, C.; Rowe, I. A.; Houlihan, D. D.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 37:Issue 9(2013)
• Page Start: 845
• Page End: 854
• Publication Date: 2013-03-13
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12279
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" xml:lang="en" id="apt12279-abs-0001"> <title>Summary</title> <sec id="apt12279-sec-0001" sec-type="section"> <title>Background</title> <p>Acute alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with a grave prognosis. Pentoxifylline, an oral antitumour necrosis factor agent, has been reported to reduce mortality and incidence of hepatorenal syndrome (HRS) in severe alcoholic hepatitis (SAH).</p> </sec> <sec id="apt12279-sec-0002" sec-type="section"> <title>Aim</title> <p>To summarise evidence for the use of pentoxifylline in SAH.</p> </sec> <sec id="apt12279-sec-0003" sec-type="section"> <title>Methods</title> <p>A literature search was undertaken using MeSH terms 'hepatitis, alcoholic' and 'pentoxifylline' using the set operator AND. We included randomised controlled trials examining pentoxifylline in SAH, published as abstracts or full manuscripts. Risk ratios (RRs) were calculated for pooled data using random effects modelling. Risk of bias was assessed using Cochrane group criteria and quality of trials assessed using 'Consolidated Standards of Reporting Trials' CONSORT guidelines.</p> </sec> <sec id="apt12279-sec-0004" sec-type="section"> <title>Results</title> <p>Ten trials including 884 participants were included, from six papers and four abstracts. There was significant heterogeneity between trials regarding control groups and trial end‐points. Treatment was given for 28 days in all trials except one. Pooling of data showed a reduced incidence of fatal HRS with pentoxifylline compared with placebo (RR: 0.47, 0.26–0.86, <italic>P </italic>= 0.01), but no survival benefit at 1 month (RR: 0.58, 0.31–1.07, <italic>P </italic>= 0.06). There were no significant differences between treatment groups in trials of pentoxifylline vs. corticosteroid, or vs. combination therapy.</p> </sec> <sec id="apt12279-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Pentoxifylline appears superior to placebo in prevention of fatal HRS and thus may be effective treatment of SAH when corticosteroids are contraindicated. However, multiple trials have failed to show conclusive superiority of either pentoxifylline or corticosteroids.</p> </sec> </abstract>