Title: Role of Pentoxifylline in Severe Alcoholic Hepatitis
Authors: Rasmirekha Behera, Sushant Sethi
DOI: http://dx.doi.org/10.18535/jmscr/v4i9.30
AIM: Role of Pentoxifylline is compared with placebo in the treatment of Severe Alcoholic Hepatitis. METHODS: Total 20 pts with severe alcoholic hepatitis (Maddrey DF ≥ 32) were included in the study.10 patients received pentoxifylline 400mg TDS for 4wks.And 10 patients received placebo for 4 wks. Baseline characteristics of the two groups were similar. Study was conducted for 4 wks. RESULT: Statistical Analysis was done using student’s t test. The calculated t value found to be 25.01 at 18 df which indicates the difference between Placebo and Pentoxyfylline group is highly significant (P<0.001). Higher baseline Maddrey Discriminant Function was associated with increased mortality. But Pentoxifylline lowers the Maddrey Discriminant Function thus improves survival. CONCLUSION: As compared to Placebo, Pentoxifylline reduce mortality, improved risk-benefit profile and lowers Maddrey Discriminant Function in patients with severe alcoholic hepatitis. Hence it is suggested that pentoxifylline is efficacious in treatment of severe alcoholic hepatitis. KEYWORDS: Severe Alcoholic hepatitis, Pentoxifylline, Prednisolone, Maddrey discriminant function. 1. Hardison WG,Lee FI, Prognosis in the acute liver disease of the alcoholic patients .N Engl J Med 1966;275:61-66. 2. Leevy CM.Cirrhosis in alcoholics. Med Clinics North Am 1966;52:1445-51. 3. Zhang T,Li Y,Lai JP,Douglas SD,Metzger DS,O' Brien CP,Ho WZ.Alcohol potent-iates hepatitis C virus replicon expression. Hepatology.2003;38:57-65.{Pub Med} 4. Spahr L,Giostra E,Frossard JL,Bresson-Hadni S,Rubbia-Brandt L,Hadengue A, Soluble TNF-R1,but not tumor necrosis factor alfa,predicts the 3-month mortality in patients with alcoholic hepatitis.J Hepatol 2004;41:229-234{Pub Med} 5. McCullough AJ,O'Connor JF.Alcoholic liver disease:proposed recommendation for the American College of Gastroenterology. Am J Gastroenterol.1998;93:2022-2036. [PubMed] 6. Maddrey WC,Boitnott JK,Bedine MS,Weber FL Jr,Mezey E,White RI Jr.Corticosteroid therapy of alcoholic hepatitis.Gastroenterology 1978;75:193-6. 7. Sheth M.Riggs M.Patel T (2002)."Utility of the Mayo End-stage Liver Disease (MELD) scores in assessing prognosis of patients with alcoholic hepatitis" BMC gastroenterology2:2. 8. Akriviadis E,Botla R,Briggs W,Han S, Reynolds T,Shakil O (2000), "Pentoxifyl-line improves short term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial" Gastroenterology 119 (6):1637-48. 9. Christensen E.Alcoholic hepatitis-glucocorticoids or not?J Hepatol.2002;36: 547-548.[Pub Med] 10. Agarwal K,Kontorinis N,Dieterich DT. Alcoholic Hepatitis.Current Treat Options Gastroenterol.2004;7:451-458.[PubMed] 11. Haber PS,Warner R,Seth D,Gorwell MD,McCaughan GW.Pathogenesis and management of alcoholic hepatitis.J Gastroenterol Hepatol.2003;18:1332-1344. [PubMed] 12. Strieter R,Remick D,Ward P,Spengler RN,Lynch JP 3rd,Larrick J.Cellular and molecular regulation of tumor necrosis factor alfa production by pentoxifylline. Biochem Biophys Res Commun 1988; 155:1230-6. 13. Bienvenu J,Coulon L,Barbier Y,et al.Study of pentoxifylline induced modulation of TNF alfa and interleukin-6 secretion in healthy and septic patients by the use of an ex-vivo model on whole blood.Nouv Rev Fr Hematol 1992;34 (suppl)S 1-3. 14. Raetsch C,Jia JD,Boigk G,Bauer M,Hahn EG, Riecken EO,Schuppan D. Pentoxifyl-line down regulates profibrogenic cytokinees and procollagen 1 expression in rat secondary billiary fibrosis. Gut. 2002; 50:241-247. 15. Lee KS,Cottam HB,Houglum K, Wasson DB,Carson D,Chojkier M.Pentoxifylline blocks hepatic stellate cell activation independently of phosphodiesterase inhibitory activity. Am J Physiol.1997; 273:G1094-G1100. 16. Windmeier C, Gressner AM. Pharmacolo-gical aspects of pentoxifylline with emphasis on its inhibitory action on hepatic fibrogenesis. Gen Pharmacol. 1997; 29:181-196Abstract
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