• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics Emergency Classics

Prednisolone vs placebo in severe alcoholic hepatitis [Classics Series]

byShaidah Deghan, MSc. MDandAndrew Cheung, MD MBA
May 12, 2015
in Emergency Classics, General Medicine Classics, Surgery Classics, The Classics
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. Compared to placebo, treating patients with severe alcoholic hepatitis with 28 days of prednisolone significantly improved the short-term survival up to 6 months.

2. There remains significant controversy surrounding the use of glucocorticoids in managing severe alcoholic hepatitis, as numerous other trials have demonstrated no mortality benefit, but significantly higher risk of infection with glucocorticoid therapy.

Original Date of Publication: February 1992

Study Rundown: Alcoholic hepatitis is a form of acute liver disease that may develop in individuals with prolonged, heavy alcohol intake. In patients with alcoholic hepatitis, conventional management consists of abstinence from alcohol, correction of dietary deficiencies, and supportive care. Maddrey discriminant function is a prognostic tool that is used to assess the severity of alcoholic hepatitis. Patients with scores ≥32 are termed severe alcoholic hepatitis, and experience significantly higher rates of morbidity and mortality than those with less severe disease. Prior to this study, several randomized trials had explored using glucocorticoids in managing alcoholic hepatitis, though results were conflicting. Meta-analyses of these trials suggested that there may be a benefit of using glucocorticoids in patients with severe disease. Thus, the purpose of this trial was to determine whether treating patients with severe alcoholic hepatitis with glucocorticoids would significantly reduce mortality as compared with placebo. In summary, corticosteroid therapy was found to significantly reduce mortality in patients with severe alcoholic hepatitis, as characterized by Maddrey discriminant function ≥32 or hepatic encephalopathy. Subsequent studies of glucocorticoids have continued to produce conflicting results, and there remains controversy surrounding their use in managing alcoholic hepatitis, as other studies have demonstrated significantly higher rates of infection with prednisolone therapy. While pentoxifylline has also been studied in severe alcoholic hepatitis, the results describing their effects have also been conflicting.

Click to read the study in NEJM

In-Depth [randomized controlled study]: A total of 65 participants were selected from 2 hospitals in France and randomized to treatment with prednisolone 40 mg daily or placebo for 28 days. Patients unable to take oral medications received intravenous infusions of prednisolone or placebo. Patients were eligible for the trial if they had biopsy-proven alcoholic hepatitis and severe alcoholic hepatitis (i.e., spontaneous hepatic encephalopathy or Maddrey discriminant score ≥32). Exclusion criteria included gastrointestinal bleeding or bacterial infection that could not effectively be treated within the first 48 hours. The primary endpoint was mortality within 2 months.

The two groups did not differ with regards to sex, age, duration of hospitalization before entry into the study, the presence of ascities, spontaneous hepatic encephalopathy, or esophageal varices. Survival in the prednisolone group was 88±5% and 88±5% at 1 and 2 months, respectively, compared to 62±9% and 45±8% in the placebo group for the same timepoints. Survival was significantly better in patients treated with corticosteroid than those taking placebo, regardless of the presence or absence of encephalopathy (adjusted log-rank test 9.9; p = 0.0017). The cumulative six-month survival rates were 84±6% in the prednisolone group and 45±9% in the placebo group (low-rank test 9.5; p = 0.002).

RELATED REPORTS

Drinking characteristics in adolescence predict alcohol behaviors in early adulthood

The 2 Minute Medicine Podcast Episode 8

The Scan by 2 Minute Medicine®: Maternity Leave Left Out, Dry January, A Measles Resurgence, Dr. GPT

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. No article should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2 Minute Medicine, Inc.

Tags: Alcoholcorticosteroidliver disease
Previous Post

Self-identified lesbians associated with decreased HPV vaccination

Next Post

Mediterranean diet may reduce age-related neurocognitive decline

RelatedReports

Greater prenatal alcohol exposure trajectories linked to impaired growth and neurodevelopment
Chronic Disease

Drinking characteristics in adolescence predict alcohol behaviors in early adulthood

March 24, 2023
2MM Podcast

The 2 Minute Medicine Podcast Episode 8

February 9, 2023
The Scan by 2 Minute Medicine®:  Ultra-Trail du Mont-Blanc, Taylor Swift, NBA rookie Chet Holmgren and Magic Mushrooms!
The Scan by 2 Minute Medicine®

The Scan by 2 Minute Medicine®: Maternity Leave Left Out, Dry January, A Measles Resurgence, Dr. GPT

March 14, 2023
Survival greater in cervical cancer patients undergoing abdominal hysterectomy compared to minimally invasive techniques: the LACC trial
Surgery

Methylprednisolone after hip replacement surgery improves pain and sleep quality

January 24, 2023
Next Post
Mediterranean diet may reduce age-related neurocognitive decline

Mediterranean diet may reduce age-related neurocognitive decline

Clinical decision rule highly sensitive in predicting subarachnoid hemorrhage

2 Minute Medicine Rewind May 3 – May 10, 2015

Reduced doses of human papillomavirus vaccine may be effective in preventing condyloma

HPV vaccinations for boys can increase benefits of vaccination program

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy
  • Drinking characteristics in adolescence predict alcohol behaviors in early adulthood
  • Sodium-glucose co-transporter-2 inhibitors may decrease risk of in-stent thrombosis
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options