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Colegio de Medicina Interna de México.

2014, Number 1

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Med Int Mex 2014; 30 (1)

Severe Alcoholic Hepatitis: Pentoxifylline as a Rescue Treatment in Patients not Responding to Steroids

Arredondo-Andrade SA, Elizalde-Barrera CI, Vargas-Ayala G

Language: Spanish
References: 19
Page: 32-42
PDF size: 694.69 Kb.


ABSTRACT

Background: Alcoholic hepatitis is a major health problem in Mexico. In the treatment of alcoholic hepatitis various drugs have been used in order to increase survival; currently steroid is the standard treatment started to be determined as alcoholic hepatitis when obtained discriminatory index greater than 32. The decision to stop prednisolone for lack of efficacy may be made by the model of Lille. However, no treatment has been established to help the survival of patients who are non-responders.
Objective: To determine survival in patients with severe alcoholic hepatitis non-responders to steroids receiving pentoxifylline as rescue therapy.
Material and method: A controlled clinical trial was done with a sample of 74 patients diagnosed with severe alcoholic hepatitis, forming two groups: group of pentoxifylline: nonresponders to treatment with steroid, determined with the model of Lille greater than 0.45, and in control group steroid treatment was continued. Clinical and laboratory variables were measured at day 0, 7 and 28. Mortality was assessed with survival curves. Descriptive statistics, percentages and averages were used.
Results: Of the patients included in the study, 66 men and 8 women, the mean age was of 45 years. During the study 6 patients from the pentoxifylline group died, as well as 17 patients from the prednisone group. We found that mortality was lower in patients who received rescue pentoxifylline, with a statistically significant protective association (p‹0.01), with a relative risk of 0.35 (95% confidence interval [CI]: 0.15 to 0.79), indicating that it is a protective factor for the pentoxifylline group. To compare survival between the two treatment groups it was observed in Kaplan-Meier curves an increased survival with the use of pentoxifylline. There was no statistically significant association between the scale of Lille ›0.6 and mortality with a p› 0.05, with relative risk of 1.2 (95% CI: 0.51-2.01).
Conclusions: In patients with severe alcoholic hepatitis not responding to treatment with steroids, pentoxifylline was shown to decrease mortality and improve survival used as rescue therapy.


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