Steroids of No Benefit for Severe Alcoholic Hepatitis

Severe alcoholic hepatitis as defined by a Maddrey’s Discriminant Function [MDF] score, >32 can carry risk for 1-month mortality of greater than 50%. Current AASLD guidelines recommend corticosteroids (prednisolone 40 mg daily for 28 days) for patients with severe acute alcoholic hepatitis, with presumptive benefit for reducing liver inflammation and possible mortality benefit This is given Class 1A evidence but is based on 13 clinical trials up to 40 years old all with a small number of patients.  However, not all studies have demonstrated consistent therapeutic benefits for steroids, even in high-risk patients.

In a meta-analysis of 16 randomized clinical trials (>1800 patients with acute alcoholic hepatitis; 90% severe by MDF score) in which systemic corticosteroids (median duration, 1 month) were compared with placebo or no intervention, investigators found no benefit of steroids on 3-month mortality (28% and 30%), other serious adverse events (39% and 36%), or quality-of-life measures. Study outcomes were unchanged in analysis of subgroups with lower or higher corticosteroid dosing or severe or less-severe alcoholic hepatitis.

References:

O’Shea, R.S.and the Practice Guideline Committee of the American Association for the Study of Liver Diseases and the Practice Parameters Committee of the American College of Gastroenterology.  AASLD Practice Guidelines:  Alcoholic Liver Disease.  Hepatology. 2010; Vol. 51, No. 1:  307.

Pavlov CS et al. Glucocorticosteroids for people with alcoholic hepatitis. Cochrane Database Syst Rev 2017 Nov 2; 11: CD001511.

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