ALCOHOLIC HEPATITIS- GLUCOCORTICOIDS MAY BE INEFFECTIVE

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ALCOHOLIC HEPATITIS- GLUCOCORTICOIDS MAY BE INEFFECTIVE

Clinical Bottom Line

Glucocorticoids may be ineffective in improving survival in patients with alcoholic hepatitis.

Citation: Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut 1995;37:113-8.

Clinical Question: In patient with alcoholic hepatitis, does treatment with glucocorticoids decrease death?

Search: alcoholic hepatitis and glucocorticoids in Best Evidence

The Study
systematic review of RCTs of patients with alcoholic hepatitis comparing steroids (< 3 months duration) with placebo/no drug therapy on survival

The Evidence:

13 studies with 659 patients
therapeutic effect weighted by sample size
effect seen only in small trials, not in large trials
poorer prognosis with encephalopathy and high bilirubin

Outcome

Relative Risk (95%CI)

Death

0.62 (0.38-1.05)

Death

0.78 (0.51-1.18) - adjusted for prognostic variables which included high bilirubin and encephalopathy

Comments:

question raised about publication bias
are there subgroups of patients who would benefit e.g. pts with - encephalopathy, presence or absence of GI bleeding, presence or absence of infection
requires further studies

Appraised by: Straus, Feb 19/98
Expiry Date: Feb/99

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Outcome	Relative Risk (95%CI)
Death	0.62 (0.38-1.05)
Death	0.78 (0.51-1.18) - adjusted for prognostic variables which included high bilirubin and encephalopathy