title: Treatment of Severe Alcoholic Hepatitis With Corticosteroid, Pentoxifylline, or Dual Therapy: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  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. Combinations of the following keywords and controlled vocabularies were searched: alcoholic hepatitis, corticosteroid, and pentoxifylline.
  
  
  RESULTS
  A total of 2639 patients from 25 studies were included. The treatment groups did not differ significantly in terms of overall mortality. Analysis of 1-month mortality revealed corticosteroid monotherapy reduced mortality compared with placebo (OR=0.58; 95% CI, 0.34-0.98; P=0.04), but pentoxifylline monotherapy did not. The mortality with dual therapy was similar to corticosteroid monotherapy (OR=0.91; 95% CI, 0.62-1.34; P=0.63). However, dual therapy decreased the incidences of hepatorenal syndrome or acute kidney injury (OR=0.47; 95% CI, 0.26-0.86; P=0.01) and the infection risk (OR=0.63; 95% CI, 0.41-0.97; P=0.04) significantly more than corticosteroid monotherapy did. None of the treatments conferred any medium-term or long-term survival benefits in the present study.
  
  
  CONCLUSIONS
  Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection. Therefore, dual therapy might be considered in treatment of patients with severe alcoholic hepatitis.
authors.affiliation: *Department of Internal Medicine, Korea University College of Medicine †Department of Preventive Medicine, Institute for Evidence-based Medicine, College of Medicine, Korea University, Seoul, Korea.
authors.forename: Young-Sun
authors.initials: YS
authors.lastname: Lee
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Yang Jae
authors.initials: YJ
authors.lastname: Yoo
authors.forename: Tae Suk
authors.initials: TS
authors.lastname: Kim
authors.forename: Seong Hee
authors.initials: SH
authors.lastname: Kang
authors.forename: Sang Jun
authors.initials: SJ
authors.lastname: Suh
authors.forename: Moon Kyung
authors.initials: MK
authors.lastname: Joo
authors.forename: Young Kul
authors.initials: YK
authors.lastname: Jung
authors.forename: Beom Jae
authors.initials: BJ
authors.lastname: Lee
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Jong-Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006519:Hepatitis, Alcoholic / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D010431:Pentoxifylline / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016166:Free Radical Scavengers; D010431:Pentoxifylline