From the Guidelines
Corticosteroids are indicated for patients with severe alcoholic hepatitis due to alcoholic cirrhosis, with a Maddrey's Discriminant Function (MDF) score ≥32, and who do not have contraindications to steroid therapy, as they improve short-term survival. The standard regimen is prednisolone 40 mg daily (or methylprednisolone 32 mg daily) for 28 days, followed by a taper over 2-4 weeks 1. Before starting treatment, patients should be screened for contraindications including active infection, gastrointestinal bleeding, renal failure, or diabetes with poor control. Response to therapy should be assessed after 7 days using the Lille score; if the score is >0.45, indicating non-response, steroids should be discontinued to avoid unnecessary side effects 1.
Some key points to consider:
- The use of corticosteroids in severe alcoholic hepatitis is supported by recent guidelines and studies, which demonstrate an improvement in short-term survival 1.
- The Lille score is a useful tool for assessing response to corticosteroid therapy and identifying non-responders, who may require alternative treatments 1.
- Complete alcohol abstinence is essential during and after treatment, and nutritional support should be provided alongside steroid therapy 1.
- Patients should be monitored for complications of steroid therapy, including infections, hyperglycemia, and psychiatric disturbances 1.
- The combination of N-acetylcysteine and corticosteroids may be considered in patients with severe alcoholic hepatitis, although further studies are needed to confirm its efficacy 1.
Overall, the use of corticosteroids in severe alcoholic hepatitis due to alcoholic cirrhosis is a well-established treatment approach that can improve short-term survival, but it requires careful patient selection and monitoring to minimize potential complications.
From the Research
Indications for Steroids in Alcoholic Cirrhosis
The use of corticosteroids in patients with severe alcoholic hepatitis due to alcoholic cirrhosis is a topic of significant interest. The primary indication for corticosteroids in this context is to improve short-term survival in patients with severe disease.
Patient Selection
- Patients with a model for end-stage liver disease (MELD) score >20 are considered to have severe alcohol-associated hepatitis and may benefit from corticosteroid therapy 2.
- The optimal range of MELD scores for corticosteroid effectiveness is between 21 and 51, with the maximum effect observed in patients with MELD scores between 25 and 39 2.
- Patients with MELD scores higher than 51 may not benefit from corticosteroid therapy 2.
Comparison with Other Treatments
- Corticosteroids have been compared to pentoxifylline in several studies, with results suggesting that corticosteroids may be more effective in improving short-term survival 3, 4.
- The combination of corticosteroids and pentoxifylline has not been shown to have an additional survival advantage compared to corticosteroids alone 5.
Historical Context
- Early studies demonstrated the efficacy of corticosteroids in improving short-term survival in patients with severe alcoholic hepatitis 6.
- These findings have been consistently supported by subsequent studies, solidifying the role of corticosteroids in the treatment of severe alcoholic hepatitis due to alcoholic cirrhosis.