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Prednisolone or Pentoxifylline for Alcoholic Hepatitis

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https://www.readbyqxmd.com/read/27922027/a-day-4-lille-model-predicts-response-to-corticosteroids-and-mortality-in-severe-alcoholic-hepatitis
#1
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...
December 6, 2016: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27646933/current-and-upcoming-pharmacotherapy-for-non-alcoholic-fatty-liver-disease
#2
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...
September 19, 2016: Gut
https://www.readbyqxmd.com/read/27636406/treatment-of-severe-alcoholic-hepatitis-with-corticosteroid-pentoxifylline-or-dual-therapy-a-systematic-review-and-meta-analysis
#3
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...
September 15, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27404293/corticosteroids-versus-pentoxifylline-for-severe-alcoholic-hepatitis-a-sequential-analysis-of-randomized-controlled-trials
#4
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
#5
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
https://www.readbyqxmd.com/read/27350941/current-management-of-alcoholic-hepatitis-and-future-therapies
#6
REVIEW
Behnam Saberi, Alia S Dadabhai, Yoon-Young Jang, Ahmet Gurakar, Esteban Mezey
Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. It encompasses a spectrum of disease, including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis. AH can range from mild to severe disease, with severe disease being defined as: Discriminant Function (DF) ≥ 32, or Model for End-stage Liver Disease (MELD) ≥ 21, or presence of hepatic encephalopathy. Management of the mild disease consists mainly of abstinence and supportive care...
June 28, 2016: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/27170388/pathogenesis-and-management-of-alcoholic-liver-disease
#7
M Omar Farooq, Ramon Bataller
Alcoholic liver disease (ALD) is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disorders ranging from asymptomatic steatosis, alcoholic steatohepatitis, fibrosis, cirrhosis and its related complications. Moreover, patients can develop an acute-on-chronic form of liver failure called alcoholic hepatitis (AH). Most patients are diagnosed at advanced stages of the disease with higher rates of complications and mortality. The mainstream of therapy of ALD patients, regardless of the disease stage, is prolonged alcohol abstinence...
2016: Digestive Diseases
https://www.readbyqxmd.com/read/27147285/the-worsening-profile-of-alcoholic-hepatitis-in-the-united-states
#8
Tuyet A Nguyen, Jonathan P DeShazo, Leroy R Thacker, Puneet Puri, Arun J Sanyal
BACKGROUND: Alcoholic hepatitis (AH) is a major cause of liver-related hospitalization. The profile, treatment patterns, and outcomes of subjects admitted for AH in routine clinical practice are unknown. Also, it is not known whether these are changing over time. This study is thus aimed to identify temporal trends in hospitalization rates, clinical characteristics, treatment patterns, and outcomes of subjects admitted for AH in a routine clinical setting. METHODS: A retrospective analysis of adults admitted for AH from 2000 to 2011 was performed using an anonymized EMR database of patient-level data from 169 U...
June 2016: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/26948886/treatment-of-severe-alcoholic-hepatitis
#9
Mark Thursz, Timothy R Morgan
Alcoholic hepatitis (AH) is a syndrome of jaundice and liver failure that occurs in a minority of heavy consumers of alcohol. The diagnosis usually is based on a history of heavy alcohol use, findings from blood tests, and exclusion of other liver diseases by blood and imaging analyses. Liver biopsy specimens, usually collected via the transjugular route, should be analyzed to confirm a diagnosis of AH in patients with an atypical history or presentation. The optimal treatment for patients with severe AH is prednisolone, possibly in combination with N-acetyl cysteine...
June 2016: Gastroenterology
https://www.readbyqxmd.com/read/26870933/therapeutic-strategies-for-the-treatment-of-alcoholic-hepatitis
#10
Ashwani K Singal, Vijay H Shah
Acute alcoholic hepatitis is a unique clinical syndrome among patients with chronic and active heavy alcohol use. Presenting with acute or chronic liver failure, a severe episode has a potential for 30 to 40% mortality at 1 month from presentation, if not recognized and left untreated. Alcoholic hepatitis patients need supportive therapy for abstinence and nutritional supplementation for those patients with markedly reduced caloric intake. Results of the recently published STOPAH (Steroids or Pentoxifylline for Alcoholic Hepatitis) Study showed only a benefit of corticosteroids on short-term mortality without any benefit of pentoxifylline...
February 2016: Seminars in Liver Disease
https://www.readbyqxmd.com/read/26860769/defective-monocyte-oxidative-burst-predicts-infection-in-alcoholic-hepatitis-and-is-associated-with-reduced-expression-of-nadph-oxidase
#11
Nikhil Vergis, Wafa Khamri, Kylie Beale, Fouzia Sadiq, Mina O Aletrari, Celia Moore, Stephen R Atkinson, Christine Bernsmeier, Lucia A Possamai, Gemma Petts, Jennifer M Ryan, Robin D Abeles, Sarah James, Matthew Foxton, Brian Hogan, Graham R Foster, Alastair J O'Brien, Yun Ma, Debbie L Shawcross, Julia A Wendon, Charalambos G Antoniades, Mark R Thursz
OBJECTIVE: In order to explain the increased susceptibility to serious infection in alcoholic hepatitis, we evaluated monocyte phagocytosis, aberrations of associated signalling pathways and their reversibility, and whether phagocytic defects could predict subsequent infection. DESIGN: Monocytes were identified from blood samples of 42 patients with severe alcoholic hepatitis using monoclonal antibody to CD14. Phagocytosis and monocyte oxidative burst (MOB) were measured ex vivo using flow cytometry, luminometry and bacterial killing assays...
February 9, 2016: Gut
https://www.readbyqxmd.com/read/26709723/pharmacotherapy-of-alcoholic-liver-disease-in-clinical-practice
#12
REVIEW
V Rosato, L Abenavoli, A Federico, M Masarone, M Persico
AIMS: Alcohol is the most commonly used addictive substance and alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide, responsible for 47.9% of all liver chronic deaths. Despite ALD has a significant burden on the health, few therapeutic advances have been made in the last 40 years, particularly in the long-term management of these patients. METHODS: we searched in PubMed, Scopus, Google Scholar, and MEDLINE databases to identify relevant English language publications focused on long-term therapy of ALD...
February 2016: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/26691209/the-clinical-effectiveness-and-cost-effectiveness-of-steroids-or-pentoxifylline-for-alcoholic-hepatitis-stopah-a-2%C3%A2-%C3%A3-%C3%A2-2-factorial-randomised-controlled-trial
#13
RANDOMIZED CONTROLLED TRIAL
Mark Thursz, Ewan Forrest, Paul Roderick, Christopher Day, Andrew Austin, John O'Grady, Stephen Ryder, Michael Allison, Dermot Gleeson, Anne McCune, David Patch, Mark Wright, Steven Masson, Paul Richardson, Luke Vale, Jane Mellor, Louise Stanton, Megan Bowers, Ian Ratcliffe, Nichola Downs, Scott Kirkman, Tara Homer, Laura Ternent
BACKGROUND: Alcoholic hepatitis (AH) is a distinct presentation of alcoholic liver disease arising in patients who have been drinking to excess for prolonged periods, which is characterised by jaundice and liver failure. Severe disease is associated with high short-term mortality. Prednisolone and pentoxifylline (PTX) are recommended in guidelines for treatment of severe AH, but trials supporting their use have given heterogeneous results and controversy persists about their benefit. OBJECTIVES: The aim of the clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis trial was to resolve the clinical dilemma on the use of prednisolone or PTX...
December 2015: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/26523207/role-of-pentoxifylline-in-non-alcoholic-fatty-liver-disease-in-high-fat-diet-induced-obesity-in-mice
#14
Simone Coghetto Acedo, Cintia Rabelo E Paiva Caria, Érica Martins Ferreira Gotardo, José Aires Pereira, José Pedrazzoli, Marcelo Lima Ribeiro, Alessandra Gambero
AIM: To study pentoxifylline effects in liver and adipose tissue inflammation in obese mice induced by high-fat diet (HFD). METHODS: Male swiss mice (6-wk old) were fed a high-fat diet (HFD; 60% kcal from fat) or AIN-93 (control diet; 15% kcal from fat) for 12 wk and received pentoxifylline intraperitoneally (100 mg/kg per day) for the last 14 d. Glucose homeostasis was evaluated by measurements of basal glucose blood levels and insulin tolerance test two days before the end of the protocol...
October 28, 2015: World Journal of Hepatology
https://www.readbyqxmd.com/read/24845609/pentoxifylline-vs-corticosteroid-to-treat-severe-alcoholic-hepatitis-a-randomised-non-inferiority-open-trial
#15
RANDOMIZED CONTROLLED TRIAL
Seung Ha Park, Dong Joon Kim, Young Seok Kim, Hyung Joon Yim, Won Young Tak, Heon Ju Lee, Joo Hyun Sohn, Ki Tae Yoon, In Hee Kim, Hyoung Su Kim, Soon Ho Um, Soon Koo Baik, June Sung Lee, Ki Tae Suk, Sang Gyune Kim, Sang Jun Suh, Soo Young Park, Tae Yeob Kim, Jae Young Jang
BACKGROUND & AIMS: Both corticosteroid and pentoxifylline reduce short-term mortality in severe alcoholic hepatitis. However, few studies have directly compared the efficacy of pentoxifylline and corticosteroid in patients with this condition. METHODS: In this multicentre, open-labelled, randomised non-inferiority trial, we assigned 121 patients with severe alcoholic hepatitis (Maddrey's discriminant function ⩾32) to receive either pentoxifylline (400 mg, 3 times daily, in 62 subjects) or prednisolone (40 mg daily, in 59 subjects)...
October 2014: Journal of Hepatology
https://www.readbyqxmd.com/read/24026598/prednisolone-with-vs-without-pentoxifylline-and-survival-of-patients-with-severe-alcoholic-hepatitis-a-randomized-clinical-trial
#16
RANDOMIZED CONTROLLED TRIAL
Philippe Mathurin, Alexandre Louvet, Alain Duhamel, Pierre Nahon, Nicolas Carbonell, Jérôme Boursier, Rodolphe Anty, Emmanuel Diaz, Dominique Thabut, Romain Moirand, Didier Lebrec, Christophe Moreno, Nathalie Talbodec, Thierry Paupard, Sylvie Naveau, Christine Silvain, Georges-Philippe Pageaux, Rodolphe Sobesky, Valérie Canva-Delcambre, Sébastien Dharancy, Julia Salleron, Thong Dao
IMPORTANCE: Prednisolone or pentoxifylline is recommended for severe alcoholic hepatitis, a life-threatening disease. The benefit of their combination is unknown. OBJECTIVE: To determine whether the addition of pentoxifylline to prednisolone is more effective than prednisolone alone. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized, double-blind clinical trial conducted between December 2007 and March 2010 in 1 Belgian and 23 French hospitals of 270 patients aged 18 to 70 years who were heavy drinkers with severe biopsy-proven alcoholic hepatitis, as indicated by recent onset of jaundice in the prior 3 months and a Maddrey score of at least 32...
September 11, 2013: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/23958271/steroids-or-pentoxifylline-for-alcoholic-hepatitis-stopah-study-protocol-for-a-randomised-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/22388710/corticosteroid-plus-pentoxifylline-is-not-better-than-corticosteroid-alone-for-improving-survival-in-severe-alcoholic-hepatitis-cope-trial
#18
RANDOMIZED CONTROLLED TRIAL
Sandeep Singh Sidhu, Omesh Goyal, Preeti Singla, Dinesh Gupta, Ajit Sood, Rajoo Singh Chhina, Ravinder Kumar Soni
BACKGROUND: Corticosteroids and pentoxifylline reduce short-term mortality in severe alcoholic hepatitis (SAH), but not to the extent desired. Combining both drugs may lead to better survival, but has not yet been studied. AIM: To compare the efficacy of corticosteroids plus pentoxifylline with that of corticosteroids alone in improving survival of SAH patients. METHODS: Of the 111 patients screened, 70 patients with SAH (Maddrey discriminant function (MDF) ≥ 32) were enrolled...
June 2012: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/20954276/alcoholic-hepatitis-2010-a-clinician-s-guide-to-diagnosis-and-therapy
#19
REVIEW
Maziyar Amini, Bruce A Runyon
Alcoholic hepatitis (AH) remains a common and life threatening cause of liver failure, especially when it is severe. Although the adjective "acute" is frequently used to describe this form of liver injury, it is usually subacute and has been developing for weeks to months before it becomes clinically apparent. Patients with this form of alcoholic liver disease usually have a history of drinking heavily for many years. While certain aspects of therapy, mainly nutritional support and abstinence are well established, significant debate has surrounded the pharmacologic treatment of AH, and many institutions practice widely varying treatment protocols...
October 21, 2010: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/19416132/review-article-the-diagnosis-and-management-of-alcoholic-hepatitis
#20
REVIEW
S M Cohen, J Ahn
BACKGROUND: Alcoholic hepatitis is a severe, cholestatic liver disease occurring in patients with alcohol abuse. Mortality is substantial; however, therapies may improve clinical outcomes. AIM: To provide an updated review of the epidemiology, diagnosis, staging and treatment of alcoholic hepatitis. METHODS: A MEDLINE literature search was performed to identify pertinent articles. Relevant clinical abstracts were also reviewed. RESULTS: Severe alcoholic hepatitis occurs in a small fraction of patients who abuse alcohol...
July 2009: Alimentary Pharmacology & Therapeutics
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