Propylthiouracil for alcoholic liver disease

  • Review
  • Intervention

Authors


Abstract

Background

Alcohol is the most common cause of liver disease in the Western world today. Randomised clinical trials have addressed the question whether propylthiouracil has any efficacy in patients with alcoholic liver disease.

Objectives

The objectives were to assess the efficacy of propylthiouracil on mortality, clinical symptoms and complications, liver biochemistry, and liver histology in patients with alcoholic liver disease. Adverse events were also analysed.

Search strategy

The Cochrane Hepato-Biliary Group Controlled Trials Register (searched July 2001), The Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2001), MEDLINE (January 1966 to July 2001), EMBASE (January 1985 to July 2001) were searched. These electronic searches were combined with full text searches. Manufacturers and researchers in the field were also contacted.

Selection criteria

Randomised clinical trials studying patients with alcoholic steatosis, alcoholic fibrosis, alcoholic hepatitis, and/or alcoholic cirrhosis were included. Interventions encompassed propylthiouracil at any dose versus placebo or no intervention. The trials could be double-blind, single-blind, or unblinded. The trials could be unpublished or published as an article, an abstract, or a letter and no language limitations were applied.

Data collection and analysis

All analyses were performed according to the intention-to-treat method. The statistical package (RevMan and MetaView) provided by the Cochrane Collaboration was used. The methodological quality of the randomised clinical trials was evaluated by components of quality and the Jadad-scale.

Main results

Combining the results of six randomised clinical trials including 710 patients demonstrated no significant effects of propylthiouracil versus placebo on mortality (Peto odds ratio (OR) 0.91, 95% confidence interval (CI) 0.59 to 1.40), liver related mortality (OR 0.78, 95% CI 0.45 to 1.33), complications of the liver disease (OR 1.14, 95% CI 0.58 to 2.24), or liver histology. Propylthiouracil was associated with a non significant trend towards an increased risk of non-serious adverse events (OR 1.49, 95% CI 0.74 to 2.99) and with the seldom occurrence of serious adverse events (leukopenia).

Authors' conclusions

This systematic review could not demonstrate any significant efficacy of propylthiouracil on any clinically important outcomes (mortality, liver related mortality, liver complications, and liver histology) of patients with alcoholic liver disease and propylthiouracil was associated with adverse events. Accordingly, there is no evidence for using propylthiouracil for alcoholic liver disease outside randomised clinical trials.

Plain language summary

Synopsis

Evidence supporting propylthiouracil for alcoholic liver disease not found

The majority of liver diseases are caused by alcohol in the Western world. Propylthiouracil - an antithyroid drug that has been used for patients with raised metabolism (so called thyrotoxicosis) - has been suggested as treatment for alcoholic liver disease. Several trials have addressed the question whether propylthiouracil has any efficacy in patients with this disease. This systematic review could not demonstrate any significant effect of propylthiouracil on any clinically meaningful outcomes (mortality, liver related mortality, liver complications, and liver histology) of patients with alcoholic liver disease. Propylthiouracil is associated with a non-significant increase in non-serious adverse events and with the seldom occurrence of serious adverse events. Accordingly, there seems to be no evidence for using propylthiouracil for alcoholic liver disease outside randomised clinical trials.