Prednisolone plus S-adenosil-L-methionine in severe alcoholic hepatitis.

Abstract:

PURPOSE/BACKGROUND:Severe alcoholic hepatitis (AH) is a life-threatening liver disease with a potential of 30-40 % mortality at 1 month. While steroids remain to be a first line therapy, they provide only about 50 % survival benefit. The aim of the study was to evaluate the efficacy of glucocorticoids plus S-adenosylmethionine (SAMe), as compared to glucocorticoids alone, in patients with severe alcoholic hepatitis. METHODS:Forty patients with severe AH were randomized in two groups and enrolled in the prospective trial. Group 1 (n = 20) patients received prednisolone 40 mg/daily per os, and group 2 (n = 20) patients were managed with prednisolone 40 mg/daily per os plus SAMe 800 mg i.v. TREATMENT:Duration was 28 days. RESULTS:The response rate assessed by Lille model was significantly higher in the prednisolone plus SAMe group (19 of 20; 95 %) than in the prednisolone group (13 of 20; 65 %), p = 0.044. Two (10 %) patients died, both from the prednisolone group. There were no lethal outcomes in the prednisolone plus SAMe group. The Kaplan-Meier method showed no significant differences between the two groups (p = 0.151, log-rank). Hepatorenal syndrome (HRS) occurred in 20 % in the prednisolone group (4 of 20 patients) while no HRS cases were registered in the prednisolone plus SAMe group (p = 0.035). CONCLUSIONS:Management of severe alcoholic hepatitis with prednisolone plus SAMe was associated with better therapy response (p = 0.044) and less frequent HRS occurrence (p = 0.035). Mortality was not significantly lower in the prednisolone-SAMe group than in the prednisolone-only group at 28 days (10 vs. 0 %, p = 0.151).

journal_name

Hepatol Int

journal_title

Hepatology international

authors

Tkachenko P,Maevskaya M,Pavlov A,Komkova I,Pavlov C,Ivashkin V

doi

10.1007/s12072-016-9751-4

subject

Has Abstract

pub_date

2016-11-01 00:00:00

pages

983-987

issue

6

eissn

1936-0533

issn

1936-0541

pii

10.1007/s12072-016-9751-4

journal_volume

10

pub_type

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