Treatment of severe alcoholic hepatitis: A systematic review. (October 2021)

• Record Type: Journal Article
• Authors: Van Melkebeke, Lukas; Korf, Hannelie; Tsochatzis, Emmanuel A.; van der Merwe, Schalk; Nevens, Frederik; Verbeek, Jef
• Is Part Of: Current opinion in pharmacology. Volume 60(2021)
• Page Start: 91
• Page End: 101
• Publication Date: 2021-10
• Subjects: Pharmacology -- Periodicals; Pharmaceutical Preparations -- Periodicals; Drug Therapy -- Periodicals; Biopharmaceutics -- Periodicals; Pharmacologie -- Périodiques; Pharmacology; Periodicals; 615.105
• DOI: 10.1016/j.coph.2021.06.011
• Languages: English
• ISSNs: 1471-4892

Abstract

Abstract: Severe alcoholic hepatitis is the most severe form of alcohol-related liver disease. Corticosteroids remain the first choice of treatment. However, they are only effective in a subset of patients and are associated with an increased infection risk. Furthermore, nonresponders to corticosteroids have a poor prognosis with a mortality of 70% over 6 months. As such, there is a high need for a more personalized use of corticosteroids and the development and identification of alternative therapeutic strategies. In this review, we summarize the recent and ongoing randomized controlled trials concerning the treatment of severe alcoholic hepatitis. Highlights: Severe alcoholic hepatitis has a high short-term mortality of 20-50%. Corticosteroids are associated with an improved survival at 28 days and remain the first choice of treatment. Granulocyte colony stimulating factor might improve 90-day survival, but this needs confirmation in Western populations. Early liver transplantation improves survival in highly selected patients who did not respond to corticosteroids. Identifying novel therapies, tailoring corticosteroid therapy, and preventing relapse of alcohol use are the unmet needs.