Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids.
OBJECTIVE
In severe alcoholic hepatitis (AH), 40% of patients will obtain no benefit from corticosteroids. Improvement in management of non-responders is warranted and only pentoxifylline can be considered an alternative. A two-step strategy was evaluated consisting of early withdrawal of corticosteroids and a switch to pentoxifylline for 28 additional days in non-responders identified using early change in bilirubin level.


METHODS
One hundred and twenty-one patients with AH were treated prospectively with corticosteroids, and the two-step strategy was proposed to 29 non-responders treated according to a two-step strategy who were compared to 58 matched non-responders treated with corticosteroids only.


RESULTS
Clinical and biological features of the two groups were similar. There was no survival improvement at 2 months in patients treated with the two-step strategy compared to controls: 35.5+/-6.3% vs 31+/-8.6%. After 21 days, biological evolution was similar for prothrombin time (-0.25s vs +0.2s), bilirubin (0.8 mg/dl vs 2.03 mg/dl) and creatinine (+0.16 mg/dl vs -0.7 mg/dl). In multivariate analysis, only age, evolution of bilirubin during the first week, creatinine and DF were associated with 2-month survival.


CONCLUSIONS
Non-responders to corticosteroids do not obtain any benefit from an early switch to pentoxifylline. Thus, the issue of management of non-responders remains unresolved.
Louvet
Alexandre
A
Services d'Hépato-Gastroentérologie, Hôpital Huriez, rue Polonovski, Lille, France.
Diaz
Emmanuel
E
Dharancy
Sébastien
S
Coevoet
Hugues
H
Texier
Frédéric
F
Thévenot
Thierry
T
Deltenre
Pierre
P
Canva
Valérie
V
Plane
Christophe
C
Mathurin
Philippe
P
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D004351:Drug Resistance; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006519:Hepatitis, Alcoholic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010431:Pentoxifylline / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011517:Prothrombin Time; D016019:Survival Analysis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D016166:Free Radical Scavengers; D011239:Prednisolone; D003404:Creatinine; D001663:Bilirubin; D010431:Pentoxifylline