This uncommissioned systematic review was subject to full peer-review.
Systematic review: pentoxifylline for the treatment of severe alcoholic hepatitis
Version of Record online: 13 MAR 2013
© 2013 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 9, pages 845–854, May 2013
How to Cite
Parker, R., Armstrong, M. J., Corbett, C., Rowe, I. A. and Houlihan, D. D. (2013), Systematic review: pentoxifylline for the treatment of severe alcoholic hepatitis. Alimentary Pharmacology & Therapeutics, 37: 845–854. doi: 10.1111/apt.12279
- Issue online: 3 APR 2013
- Version of Record online: 13 MAR 2013
- Manuscript Accepted: 19 FEB 2013
- Manuscript Revised: 18 FEB 2013
- Manuscript Revised: 12 FEB 2013
- Manuscript Received: 22 JAN 2013
Acute alcoholic hepatitis (AH) is a severe manifestation of alcoholic liver disease with a grave prognosis. Pentoxifylline, an oral antitumour necrosis factor agent, has been reported to reduce mortality and incidence of hepatorenal syndrome (HRS) in severe alcoholic hepatitis (SAH).
To summarise evidence for the use of pentoxifylline in SAH.
A literature search was undertaken using MeSH terms ‘hepatitis, alcoholic’ and ‘pentoxifylline’ using the set operator AND. We included randomised controlled trials examining pentoxifylline in SAH, published as abstracts or full manuscripts. Risk ratios (RRs) were calculated for pooled data using random effects modelling. Risk of bias was assessed using Cochrane group criteria and quality of trials assessed using ‘Consolidated Standards of Reporting Trials’ CONSORT guidelines.
Ten trials including 884 participants were included, from six papers and four abstracts. There was significant heterogeneity between trials regarding control groups and trial end-points. Treatment was given for 28 days in all trials except one. Pooling of data showed a reduced incidence of fatal HRS with pentoxifylline compared with placebo (RR: 0.47, 0.26–0.86, P = 0.01), but no survival benefit at 1 month (RR: 0.58, 0.31–1.07, P = 0.06). There were no significant differences between treatment groups in trials of pentoxifylline vs. corticosteroid, or vs. combination therapy.
Pentoxifylline appears superior to placebo in prevention of fatal HRS and thus may be effective treatment of SAH when corticosteroids are contraindicated. However, multiple trials have failed to show conclusive superiority of either pentoxifylline or corticosteroids.