Titre :

Corticosteroids Reduce Risk of Death Within 28 Days for Patients With Severe Alcoholic Hepatitis, Compared With Pentoxifylline or Placebo-a Meta-analysis of Individual Data.

Auteur(s) :

Louvet, Alexandre [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Kim, Dong Joon [Auteur]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Atkinson, Stephen [Auteur]
Sidhu, Sandeep Singh [Auteur]
O'Grady, John G. [Auteur]
Akriviadis, Evangelos [Auteur]
Sinakos, Emmanouil [Auteur]
Carithers Jr., Robert L. [Auteur]
Ramond, Marie-Jose [Auteur]
Maddrey, Willis C. [Auteur]
Morgan, Timothy R. [Auteur]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Mathurin, Philippe [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]

Titre de la revue :

Gastroenterology

Nom court de la revue :

Gastroenterology

Numéro :

155

Pagination :

458-468.e8

Date de publication :

2018-08

Mot(s)-clé(s) :

Survival
Alcoholic Hepatitis
Prednisolone
Meta-Analysis

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background & Aims We performed a meta-analysis of individual patient data from 11 randomized controlled trials comparing corticosteroids, pentoxifylline, or their combination in patients with severe alcoholic hepatitis. ...
Lire la suite >Background & Aims We performed a meta-analysis of individual patient data from 11 randomized controlled trials comparing corticosteroids, pentoxifylline, or their combination in patients with severe alcoholic hepatitis. We compared the effects of the treatments on survival for 28 days or 6 months, and response to treatment based on the Lille model. Methods We searched PubMed for randomized controlled trials of pharmacologic therapy for severe alcoholic hepatitis. Our final analysis comprised 11 studies, of 2111 patients. We performed 4 meta-analyses of the effects of corticosteroids vs placebo or control, corticosteroids vs pentoxifylline, corticosteroids and pentoxifylline vs corticosteroids and placebo or control, and pentoxifylline vs placebo. In each meta-analysis, the effect of treatment on the primary outcome (overall survival at 28 days, defined as the period from the first day of assigned treatment to 28 days) was estimated using a Cox proportional hazards regression model, including trials as random effect. Results Corticosteroid treatment significantly decreased risk of death within 28 days compared with controls (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.48–0.86) or to pentoxifylline (HR 0.64; 95% CI 0.43–0.95). In multiple-imputation and complete case analyses, the effect of corticosteroids compared with controls remained significant. When we compared corticosteroids vs pentoxifylline, the corticosteroid effect remained significant in the complete case analysis (HR 0.66; P = .04) but not in multiple-imputation analysis (HR 0.71; P = .08). There was no difference in 28-day mortality when patients were given a combination of corticosteroids and pentoxifylline vs corticosteroids alone or between patients given pentoxifylline vs control. In our analysis of secondary outcomes, we found no significant differences in 6-month mortality when any treatments or controls were compared. Corticosteroids were significantly associated with increased response to therapy compared with controls (relative risk 1.24; 95% CI 1.10–1.41) or pentoxifylline (relative risk 1.43; 95% CI 1.20–1.68). We found no difference in response to therapy between patients given a combination of corticosteroids and pentoxifylline vs corticosteroids alone or pentoxifylline vs controls. Conclusions In a meta-analysis of 4 controlled trials, we found corticosteroid use to reduce risk of death within 28 days of treatment, but not in the following 6 months. This loss of efficacy over time indicates a need for new therapeutic strategies to improve medium-term outcomes.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Équipe(s) de recherche :

Inflammatory digestive disease : pathophysiology and therapeutic targets developement

Date de dépôt :

2019-03-01T15:24:48Z
2021-06-11T13:32:27Z
2024-02-06T14:05:15Z