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Prednisolone or Pentoxifylline for Alcoholic Hepatitis

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https://www.readbyqxmd.com/read/29738698/corticosteroids-reduce-risk-of-death-within-28-days-for-patients-with-severe-alcoholic-hepatitis-compared-with-pentoxifylline-or-placebo-a-meta-analysis-of-individual-data
#1
Alexandre Louvet, Mark R Thursz, Dong Joon Kim, Julien Labreuche, Stephen Atkinson, Sandeep Singh Sidhu, John G O'Grady, Evangelos Akriviadis, Emmanouil Sinakos, Robert L Carithers, Marie-José Ramond, Willis C Maddrey, Timothy R Morgan, Alain Duhamel, Philippe Mathurin
BACKGROUND & AIMS: We performed a meta-analysis of individual patient data from 11 randomized controlled trials comparing corticosteroids, pentoxifylline, or their combination in patients with severe alcoholic hepatitis. We compared the effects of the treatments on survival for 28 days or 6 months, and response to treatment based on the Lille model. METHODS: We searched PubMed for randomized controlled trials of pharmacologic therapy for severe alcoholic hepatitis...
May 5, 2018: Gastroenterology
https://www.readbyqxmd.com/read/29708448/alcoholic-steatohepatitis-ash-and-alcoholic-hepatitis-ah-cascade-of-events-clinical-aspects-and-pharmacotherapy-options
#2
Rolf Teschke
Clinicians caring for patients with alcoholic hepatitis (AH) are often confronted with the question of the best pharmacotherapy to be used. Areas covered: This article covers metabolic aspects of alcohol as the basis of understanding pharmacotherapy and to facilitate choosing the drug therapeutic options for patients with severe AH. Expert opinion: Alcoholic steatohepatitis (ASH) and alcoholic hepatitis (AH) as terms are often used interchangeably in scientific literature but a stringent differentiation is recommended for proper clarity...
April 30, 2018: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/29663389/noncholesterol-sterols-as-surrogate-markers-in-patients-with-severe-alcoholic-hepatitis
#3
Perttu Sahlman, Markku Nissinen, Piia Simonen, Martti Färkkilä
Severe alcoholic hepatitis (AH) is a life-threatening condition lacking good serologic markers to tailor treatment and predict recovery. We examined the cholesterol metabolism in severe AH to explore prognostic markers and evaluate the profile of cholesterol precursors, cholestanol and phytosterols, in this context. We assessed serum cholesterol, cholesterol precursors, cholestanol, phytosterols, and biochemical markers in 24 patients with severe AH treated with prednisolone and randomized to ciprofloxacin in the ratio 1:1...
April 16, 2018: Lipids
https://www.readbyqxmd.com/read/29391265/efficacy-of-granulocyte-colony-stimulating-factor-and-n-acetylcysteine-therapies-in-patients-with-severe-alcoholic-hepatitis
#4
Virendra Singh, Amarjit Keisham, Ashish Bhalla, Navneet Sharma, Ritesh Agarwal, Ratiram Sharma, Akash Singh
BACKGROUND & AIMS: Patients with alcoholic hepatitis (AH) have high mortality, so new therapies are needed. Administration of granulocyte colony stimulating factor (G-CSF) increases survival times of patients with AH. It is not known whether addition of N-acetyl cysteine (NAC) to G-CSF could further increase survival time. We performed a randomized controlled pilot study to compare the efficacy of standard medical therapy with pentoxifylline to treatment with a combination of G-CSF and standard medical therapy as well as to the combination of NAC, G-CSF, and standard medical therapy in patients with severe AH...
January 31, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29340126/hepatosplenic-gamma-delta-t-cell-lymphoma-hsgdtcl-two-rare-case-reports-from-western-india
#5
Irappa Madabhavi, Gaurang Modi, Harsha Panchal, Apurva Patel, Swaroop Revannasiddaiah, Asha Anand, Sonia Parikh, Kshitij Joshi, Malay Sarkar
Peripheral T cell lymphomas are a heterogeneous group of post-thymic, mature lymphoid malignancies, accounting for approximately 10-15% of all non-Hodgkin's lymphomas. Hepatosplenic T-cell lymphoma (HSGDTCL) is a rare entity, which is characterized by primary extra nodal disease with typical sinusoidal or sinusal infiltration of the liver and the spleen, respectively by expression of the T-cell receptor γδ chain, and by a number of other frequent clinicopathologic features, including aggressive course of disease...
October 1, 2017: International Journal of Hematology-oncology and Stem Cell Research
https://www.readbyqxmd.com/read/29175535/application-of-prognostic-scores-in-the-stopah-trial-discriminant-function-is-no-longer-the-optimal-scoring-system-in-alcoholic-hepatitis
#6
Ewan H Forrest, Stephen R Atkinson, Paul Richardson, Steven Masson, Stephen Ryder, Mark R Thursz, Michael Allison
BACKGROUND & AIMS: 'Static' prognostic models in alcoholic hepatitis, using data from a single time point, include the discriminant function (DF), Glasgow alcoholic hepatitis score (GAHS), the age, serum bilirubin, international normalized ratio and serum creatinine (ABIC) score and the model of end-stage liver disease (MELD). 'Dynamic' scores, incorporating evolution of bilirubin at seven days, include the Lille score. The aim of this study was to assess these scores' performance in patients from the STOPAH trial...
March 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/28966126/controversies-in-clinical-trials-for-alcoholic-hepatitis
#7
Sarah R Lieber, John P Rice, Michael R Lucey, Ramon Bataller
Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease, contributing to significant morbidity and mortality. Yet, the only available therapies that improve survival are corticosteroids and liver transplantation, with no new drugs successfully developed for decades. This article briefly describes the current state of affairs in AH therapy and examines the practical and ethical challenges of conducting controlled trials in patients with severe AH. While prednisolone is considered standard of care in severe AH, this recommendation remains controversial given the marginal benefits and questionable long-term safety of steroids...
March 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/28543549/review-article-recent-insights-into-clinical-decision-making-in-severe-alcoholic-hepatitis
#8
REVIEW
P D J Dunne, E H Forrest
BACKGROUND: Alcoholic hepatitis is a severe acute manifestation of alcoholic liver disease with a high mortality. Management of patients with this condition has been a matter of controversy for many years; however, recent clinical studies have sought to improve the clinical approach to these patients. AIM: To use these recent studies in order to guide clinical management. METHODS: A MeSH search of Medline was performed to specifically identify recent studies which influenced clinical diagnosis, assessment and management of alcoholic hepatitis...
August 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28282320/alcoholic-hepatitis-current-trends-in-management
#9
REVIEW
Ariel W Aday, Mack C Mitchell, Lisa C Casey
PURPOSE OF REVIEW: Alcohol consumption is increasing globally, as are complications of alcohol-related liver disease, including the most severe manifestation, alcoholic hepatitis. Despite the increased prevalence, many patients hospitalized with alcoholic hepatitis are either not diagnosed or inadequately treated leading to significant morbidity and high mortality rates. The purpose of this review is to discuss current challenges in the diagnosis and management of this frequently fatal condition...
May 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28247264/new-paradigms-in-management-of-alcoholic-hepatitis-a-review
#10
REVIEW
Sandeep Singh Sidhu, Omesh Goyal, Harsh Kishore, Simran Sidhu
Severe alcoholic hepatitis (SAH) is defined by modified Maddrey discriminant function ≥32 or Model for End-Stage Liver Disease (MELD) >21 and/or hepatic encephalopathy. It has a 3-month mortality rate ≥30-70 %. Patients with severe alcoholic hepatitis need combined, i.e., static (MELD score) and dynamic (Lille's score), prognostication. Systemic inflammation and poor regeneration are hallmarks of SAH, rather than intrahepatic inflammation. SAH is characterized by dysregulated and uncontrolled systemic inflammatory response followed by weak compensatory antiinflammatory response that leads to increased susceptibility to infection and multiple organ failure...
May 2017: Hepatology International
https://www.readbyqxmd.com/read/28161471/homozygosity-for-rs738409-g-in-pnpla3-is-associated-with-increased-mortality-following-an-episode-of-severe-alcoholic-hepatitis
#11
Stephen R Atkinson, Michael J Way, Andrew McQuillin, Marsha Y Morgan, Mark R Thursz
BACKGROUND & AIMS: Carriage of rs738409:G in PNPLA3 is associated with an increased risk of developing alcohol-related cirrhosis and has a significant negative effect on survival. Short-term mortality in patients with severe alcoholic hepatitis is high; drinking behaviour is a major determinant of outcome in survivors. The aim of this study was to determine whether carriage of rs738409:G has an additional detrimental effect on survival in this patient group. METHODS: Genotyping was undertaken in 898 cases with severe alcoholic hepatitis, recruited through the UK Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial, and 1188 White British/Irish alcohol dependent controls with no liver injury, recruited via University College London...
July 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28096540/alcoholic-liver-disease-alcoholic-hepatitis-a-warning-for-prednisolone-and-infection-risk
#12
COMMENT
Katrina Ray
No abstract text is available yet for this article.
February 2017: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28043903/in-patients-with-severe-alcoholic-hepatitis-prednisolone-increases-susceptibility-to-infection-and-infection-related-mortality-and-is-associated-with-high-circulating-levels-of-bacterial-dna
#13
RANDOMIZED CONTROLLED TRIAL
Nikhil Vergis, Stephen R Atkinson, Suzanne Knapp, James Maurice, Michael Allison, Andrew Austin, Ewan H Forrest, Steven Masson, Anne McCune, David Patch, Paul Richardson, Dermot Gleeson, Stephen D Ryder, Mark Wright, Mark R Thursz
BACKGROUND & AIMS: Infections are common in patients with severe alcoholic hepatitis (SAH), but little information is available on how to predict their development or their effects on patients. Prednisolone is advocated for treatment of SAH, but can increase susceptibility to infection. We compared the effects of infection on clinical outcomes of patients treated with and without prednisolone, and identified risk factors for development of infection in SAH. METHODS: We analyzed data from 1092 patients enrolled in a double-blind placebo-controlled trial to evaluate the efficacy of treatment with prednisolone (40 mg daily) or pentoxifylline (400 mg 3 times each day) in patients with SAH...
April 2017: Gastroenterology
https://www.readbyqxmd.com/read/27979049/medical-management-of-severe-alcoholic-hepatitis-expert-review-from-the-clinical-practice-updates-committee-of-the-aga-institute
#14
REVIEW
Mack C Mitchell, Lawrence S Friedman, Craig J McClain
The purpose of this clinical practice update is to review diagnostic criteria for severe acute alcoholic hepatitis and to determine the current best practices for this life-threatening condition. The best practices in this review are based on clinical trials, systematic reviews including meta-analysis and expert opinion to develop an approach to diagnosis and management. Best Practice Advice 1: Abstinence from drinking alcohol is the cornerstone of treatment for alcohol hepatitis (AH). Best Practice Advice 2: Patients with jaundice and suspected AH should have cultures of blood, urine, and ascites, if present, to determine the presence of bacterial infections regardless of whether they have fever...
January 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27965666/critical-roles-of-kupffer-cells-in-the-pathogenesis-of-alcoholic-liver-disease-from-basic-science-to-clinical-trials
#15
REVIEW
Tao Zeng, Cui-Li Zhang, Mo Xiao, Rui Yang, Ke-Qin Xie
Alcoholic liver disease (ALD) encompasses a spectrum of liver injury ranging from steatosis to steatohepatitis, fibrosis, and finally cirrhosis. Accumulating evidences have demonstrated that Kupffer cells (KCs) play critical roles in the pathogenesis of both chronic and acute ALD. It has become clear that alcohol exposure can result in increased hepatic translocation of gut-sourced endotoxin/lipopolysaccharide, which is a strong M1 polarization inducer of KCs. The activated KCs then produce a large amount of reactive oxygen species (ROS), pro-inflammatory cytokines, and chemokines, which finally lead to liver injury...
2016: Frontiers in Immunology
https://www.readbyqxmd.com/read/27922027/a-day-4-lille-model-predicts-response-to-corticosteroids-and-mortality-in-severe-alcoholic-hepatitis
#16
Mauricio Garcia-Saenz-de-Sicilia, Chitharanjan Duvoor, Jose Altamirano, Roberta Chavez-Araujo, Veronica Prado, Ana de Lourdes Candolo-Martinelli, Patricia Holanda-Almeida, Bernardo Becerra-Martins-de-Oliveira, Simony Fernandez-de-Almeida, Ramón Bataller, Juan Caballeria, Andres Duarte-Rojo
OBJECTIVES: Prednisolone therapy increases the risk of infections in patients with severe alcoholic hepatitis (SAH). We evaluated whether the use of the Lille Model at day 4 (LM4) is useful to predict response to prednisolone compared with the classic day 7 (LM7) in order to limit a futile exposure to corticosteroids. METHODS: We performed a retrospective analysis of a large multinational cohort of patients with SAH with Maddrey's discriminant function (DF) ≥32...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27646933/current-and-upcoming-pharmacotherapy-for-non-alcoholic-fatty-liver-disease
#17
REVIEW
Yaron Rotman, Arun J Sanyal
Given the high prevalence and rising incidence of non-alcoholic fatty liver disease (NAFLD), the absence of approved therapies is striking. Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy as well. A greater understanding of disease pathogenesis in recent years was followed by development of new classes of medications, as well as potential repurposing of currently available agents. NAFLD therapies target four main pathways. The dominant approach is targeting hepatic fat accumulation and the resultant metabolic stress...
January 2017: Gut
https://www.readbyqxmd.com/read/27636406/treatment-of-severe-alcoholic-hepatitis-with-corticosteroid-pentoxifylline-or-dual-therapy-a-systematic-review-and-meta-analysis
#18
REVIEW
Young-Sun Lee, Hyun Jung Kim, Ji Hoon Kim, Yang Jae Yoo, Tae Suk Kim, Seong Hee Kang, Sang Jun Suh, Moon Kyung Joo, Young Kul Jung, Beom Jae Lee, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Jae Seon Kim, Jong-Jae Park, Soon Ho Um, Young-Tae Bak, Kwan Soo Byun
BACKGROUND AND AIMS: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015...
April 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27404293/corticosteroids-versus-pentoxifylline-for-severe-alcoholic-hepatitis-a-sequential-analysis-of-randomized-controlled-trials
#19
REVIEW
Basile Njei, Albert Do, Thomas R McCarty, Brett E Fortune
INTRODUCTION: Despite the significant morbidity and mortality associated with alcoholic hepatitis, a consensus or generally accepted therapeutic strategy has not yet been reached. The purpose of this analysis was to evaluate the effects of corticosteroids and pentoxifylline on short-term mortality, incidence of hepatorenal syndrome, and sepsis in patients with severe alcoholic hepatitis. MATERIALS AND METHODS: We conducted a comprehensive search of the Cochrane library, PUBMED, Scopus, EMBASE, and published proceedings from major hepatology and gastrointestinal meetings from January 1970 to June 2015...
November 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27373613/acute-alcoholic-hepatitis-therapy
#20
REVIEW
Paulina K Phillips, Michael R Lucey
Alcoholic hepatitis (AH) causes great morbidity and mortality in the United States and throughout the world. Advances in therapy have proven difficult. In part, this reflects challenges in diagnosis, including the distinction between AH and acute-on-chronic liver failure. Liver biopsy is the best method to clarify the cause in circumstances whereby conflicting clinical data confound the diagnosis. All treatment of AH begins with abstinence from alcohol. All patients with AH should be given sufficient nutrition...
August 2016: Clinics in Liver Disease
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