What is the treatment for alcoholic hepatitis?

From the Guidelines

The treatment for alcoholic hepatitis primarily involves complete alcohol cessation, which is the most critical intervention, and for severe cases, corticosteroids like methylprednisolone (32 mg daily) are recommended for patients without contraindications, as supported by the most recent and highest quality study 1. For mild cases, supportive care with nutritional support and abstinence may be sufficient. In severe alcoholic hepatitis, the use of corticosteroids has been shown to improve short-term survival without a medium- or long-term survival benefit. The combination of N-acetylcysteine and corticosteroids may be offered to patients with a severe form of alcoholic hepatitis, although confirmatory studies are necessary. Pentoxifylline is no longer recommended due to its ineffectiveness, as stated in the guidelines 1. Nutritional therapy is essential, with a recommended protein intake and caloric intake, and vitamin supplementation helps address common deficiencies. Management of complications like ascites, hepatic encephalopathy, and varices follows standard protocols. For patients with severe disease not responding to medical therapy, liver transplantation may be considered after a period of abstinence, with a rigorous selection process, as recommended in the guidelines 1. These treatments work by reducing liver inflammation, supporting liver regeneration, and preventing further damage while the liver heals, ultimately improving morbidity, mortality, and quality of life outcomes. Key considerations include assessing disease severity using prognostic scores like the Maddrey discriminant function or the Glasgow alcoholic hepatitis score, and evaluating treatment response at day 7 using the Lille score, as outlined in the clinical practice guidelines 1. Overall, the management of alcoholic hepatitis requires a comprehensive approach that addresses the underlying causes, supports liver function, and prevents further liver damage, with the goal of improving patient outcomes.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage of Prednisolone Oral Solution should be individualized according to the severity of the disease and the response of the patient. The treatment for alcoholic hepatitis may involve the use of prednisolone, with the dosage individualized according to the severity of the disease and the response of the patient 2.

• The initial dosage of Prednisolone Oral Solution may vary from 5 mg to 60 mg per day.
• The dosage should be adjusted until a satisfactory response is noted.
• It is essential to monitor the patient's condition and adjust the dosage as needed to maintain an adequate clinical response.

From the Research

Treatment Options for Alcoholic Hepatitis

The treatment for alcoholic hepatitis involves a combination of supportive care, medications, and potentially liver transplantation. Some key points to consider include:

• Supportive therapy for abstinence and nutritional supplementation are crucial for patients with markedly reduced caloric intake 3
• Corticosteroids, such as prednisolone, have been shown to improve short-term mortality, but not medium- and long-term mortality 3, 4
• Pentoxifylline has not been shown to improve survival in patients with alcoholic hepatitis 5, 4
• Fecal microbiota transplantation (FMT) has been shown to improve 90-day survival and reduce infections in severe alcoholic hepatitis patients 6
• Liver transplantation may be a viable option for highly select patients with severe alcoholic hepatitis, but more research is needed to determine the best candidates and post-transplant management strategies 3, 7

Medications Used in Treatment

Some medications that have been studied for the treatment of alcoholic hepatitis include:

• Prednisolone: a corticosteroid that has been shown to improve short-term mortality, but not medium- and long-term mortality 3, 4
• Pentoxifylline: a medication that has not been shown to improve survival in patients with alcoholic hepatitis 5, 4
• Fecal microbiota transplantation (FMT): a treatment that involves transplanting healthy gut bacteria into the patient, which has been shown to improve 90-day survival and reduce infections in severe alcoholic hepatitis patients 6

Emerging Treatments and Research

There are several emerging treatments and areas of research for alcoholic hepatitis, including:

• New or repurposed compounds that target various pathways in the pathogenesis of alcoholic hepatitis, such as the gut-liver axis, the inflammatory cascade, and liver injury 3
• Liver transplantation as a potential treatment option for highly select patients with severe alcoholic hepatitis 3, 7
• Fecal microbiota transplantation (FMT) as a potential treatment option for severe alcoholic hepatitis patients 6