Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial.
OBJECTIVE
To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis, and to evaluate the role of different liver function scores in predicting prognosis.


METHODS
Sixty-eight patients with severe alcoholic hepatitis (Maddrey score > or = 32) received pentoxifylline (n = 34, group I) or prednisolone (n = 34, group II) for 28 d in a randomized double-blind controlled study, and subsequently in an open study (with a tapering dose of prednisolone) for a total of 3 mo, and were followed up over a period of 12 mo.


RESULTS
Twelve patients in group II died at the end of 3 mo in contrast to five patients in group I. The probability of dying at the end of 3 mo was higher in group II as compared to group I (35.29% vs 14.71%, P = 0.04; log rank test). Six patients in group II developed hepatorenal syndrome as compared to none in group I. Pentoxifylline was associated with a significantly lower model for end-stage liver disease (MELD) score at the end of 28 d of therapy (15.53 +/- 3.63 vs 17.78 +/- 4.56, P = 0.04). Higher baseline Maddrey score was associated with increased mortality.


CONCLUSIONS
Reduced mortality, improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.
De
Binay Krishna
BK
Department of Medicine, Medical College & Hospitals, Calcutta, India. binaykde@hotmail.com
Gangopadhyay
Subhabrata
S
Dutta
Deep
D
Baksi
Sumanta Das
SD
Pani
Adyapad
A
Ghosh
Pramit
P