title: Systematic review: pentoxifylline for the treatment of severe alcoholic hepatitis.
abstract: BACKGROUND
  Acute alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with a grave prognosis. Pentoxifylline, an oral antitumour necrosis factor agent, has been reported to reduce mortality and incidence of hepatorenal syndrome (HRS) in severe alcoholic hepatitis (SAH).
  
  
  OBJECTIVE
  To summarise evidence for the use of pentoxifylline in SAH.
  
  
  METHODS
  A literature search was undertaken using MeSH terms 'hepatitis, alcoholic' and 'pentoxifylline' using the set operator AND. We included randomised controlled trials examining pentoxifylline in SAH, published as abstracts or full manuscripts. Risk ratios (RRs) were calculated for pooled data using random effects modelling. Risk of bias was assessed using Cochrane group criteria and quality of trials assessed using 'Consolidated Standards of Reporting Trials' CONSORT guidelines.
  
  
  RESULTS
  Ten trials including 884 participants were included, from six papers and four abstracts. There was significant heterogeneity between trials regarding control groups and trial end-points. Treatment was given for 28 days in all trials except one. Pooling of data showed a reduced incidence of fatal HRS with pentoxifylline compared with placebo (RR: 0.47, 0.26-0.86, P = 0.01), but no survival benefit at 1 month (RR: 0.58, 0.31-1.07, P = 0.06). There were no significant differences between treatment groups in trials of pentoxifylline vs. corticosteroid, or vs. combination therapy.
  
  
  CONCLUSIONS
  Pentoxifylline appears superior to placebo in prevention of fatal HRS and thus may be effective treatment of SAH when corticosteroids are contraindicated. However, multiple trials have failed to show conclusive superiority of either pentoxifylline or corticosteroids.
authors.affiliation: NIHR Centre for Liver Research and Biomedical Research Unit, University of Birmingham, Birmingham, UK. richardparker@nhs.net
authors.forename: R
authors.initials: R
authors.lastname: Parker
authors.forename: M J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: C
authors.initials: C
authors.lastname: Corbett
authors.forename: I A
authors.initials: IA
authors.lastname: Rowe
authors.forename: D D
authors.initials: DD
authors.lastname: Houlihan
mesh_terms: D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D010431:Pentoxifylline / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D010726:Phosphodiesterase Inhibitors; D010431:Pentoxifylline