From the Guidelines
The recommended dose of prednisolone for treating alcoholic hepatitis is typically 40 mg daily for 28 days. This regimen is generally prescribed for patients with severe alcoholic hepatitis, defined as those with a discriminant function score greater than 32 or with hepatic encephalopathy 1. The medication should be taken orally as a single daily dose, preferably in the morning to mimic the body's natural cortisol rhythm. After the 28-day treatment period, the medication can be discontinued without tapering in most cases. Before starting treatment, patients should be screened for contraindications including active infection, gastrointestinal bleeding, or diabetes with poor glucose control. During treatment, patients should be monitored for potential side effects including hyperglycemia, fluid retention, increased infection risk, and psychiatric disturbances. Importantly, prednisolone therapy should be accompanied by complete alcohol abstinence and nutritional support. The medication works by reducing inflammation in the liver through suppression of pro-inflammatory cytokines and immune responses, thereby decreasing hepatocyte damage and promoting recovery of liver function.
Some key points to consider when treating alcoholic hepatitis with prednisolone include:
- The Lille score should be calculated on the seventh day of treatment to identify patients not responding to treatment 1.
- Patients with a Lille score ≥ 0.45 are considered treatment non-responders and corticosteroid therapy must be stopped in those with a Lille score ≥ 0.56 1.
- The investigation for infection must be systematically carried out in severe forms of alcoholic hepatitis 1.
- Combining the Lille and MELD scores is the optimal approach for evaluating short- and medium-term risk of death 1.
- Survival in the first 3 months is related to the severity of alcoholic hepatitis and early liver function improvement 1.
- Long-term outcomes depend mainly on achieving abstinence, and addiction treatment must be systematically offered after an episode of alcoholic hepatitis 1.
The most recent and highest quality study, published in 2022, supports the use of prednisolone 40 mg/day for 28 days in patients with severe alcoholic hepatitis 1. This study recommends corticosteroid therapy for patients with a severe form of alcoholic hepatitis, defined as a Maddrey score ≥ 32 or with hepatic encephalopathy, without contraindications to corticosteroid use.
From the Research
Recommended Dose of Prednisolone for Alcoholic Hepatitis
The recommended dose of prednisolone for treating alcoholic hepatitis is:
- 40 mg of prednisolone once a day 2, 3, 4, 5 Some studies have used this dose for 28 days 2, 3, 4, while others have tapered the dose as soon as serum bilirubin and prothrombin time decreased below 50% of their baseline values 6
Treatment Duration and Combination Therapy
- The treatment duration can vary from 28 days to several months, depending on the patient's response to therapy 2, 3, 4, 6
- Combination therapy with other medications, such as pentoxifylline or S-adenosylmethionine (SAMe), has been studied, but the results are inconclusive 2, 3, 4
- Enteral nutrition has also been used in combination with prednisolone, with promising results in a pilot study 6
Key Findings
- Prednisolone has been shown to improve short-term survival in patients with severe alcoholic hepatitis 2, 3, 5
- The Lille model can be used to assess response to therapy and predict survival 2, 4
- Serious infections can occur in patients treated with prednisolone, highlighting the need for careful monitoring 3