From the Guidelines
The principal recommendations for the treatment of alcoholic hepatitis include corticosteroids as first-line therapy for severe cases, typically prednisolone 40 mg/day or methylprednisolone 32 mg/day, as recommended by the French Association for the Study of the Liver and the French Alcohol Society clinical guidelines 1.
Key Recommendations
- Corticosteroid therapy is recommended in patients with a severe form of alcoholic hepatitis, as it improves short-term survival without any observations of a medium- or long-term survival benefit 1.
- The combination of N-acetylcysteine and corticosteroids can be offered to patients with a severe form of alcoholic hepatitis, as it shows a short-term survival benefit at 1 and 3 months 1.
- Pentoxifylline must no longer be offered to patients with severe alcoholic hepatitis because of its ineffectiveness, as demonstrated by several recent randomized studies and meta-analyses 1.
- Fast-track liver transplantation must be considered for patients at the end of their therapeutic options, with a rigorous and multidisciplinary selection process in the reference transplant centre 1.
Treatment Approach
- Patient eligibility for steroids is determined using scoring systems like Maddrey's Discriminant Function (DF >32) or MELD score (>20) 1.
- Nutritional support is crucial, with a recommended protein intake of 1.2-1.5 g/kg/day and total caloric intake of 35-40 kcal/kg/day 1.
- Complete alcohol abstinence is essential for long-term survival, and addiction treatment must be systematically offered after an episode of alcoholic hepatitis 1.
- Early liver transplantation evaluation should be considered for select patients who don't respond to medical therapy and demonstrate commitment to sobriety, using the combined MELD and Lille scores to evaluate short- and medium-term risk of death 1.
From the Research
Principals Recommendation for the Treatment of Alcoholic Hepatitis
The principals recommendation for the treatment of alcoholic hepatitis include:
- Corticosteroids, which have been shown to reduce short-term mortality in patients with severe alcoholic hepatitis 2, 3, 4
- Pentoxifylline, which may be used in combination with corticosteroids to reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection 5, 4
- Combination therapy with corticosteroids and pentoxifylline, which may be considered for patients with severe alcoholic hepatitis, although its effectiveness in reducing mortality is unclear 5, 3, 4
Treatment Outcomes
The treatment outcomes for alcoholic hepatitis include:
- Short-term mortality, which can be reduced with corticosteroid therapy 2, 3, 4
- Medium-term and long-term mortality, which are not significantly improved with any of the current treatments 2, 6, 3, 4
- Incidence of hepatorenal syndrome or acute kidney injury, which can be reduced with dual therapy 4
- Risk of infection, which can be reduced with dual therapy 4
Current Recommendations
The current recommendations for the treatment of alcoholic hepatitis are based on the available evidence and include:
- Corticosteroids as the first-line treatment for severe alcoholic hepatitis 2, 3, 4
- Pentoxifylline as an alternative or adjunctive treatment for patients who cannot tolerate corticosteroids or have contraindications to their use 5, 4
- Combination therapy with corticosteroids and pentoxifylline for patients with severe alcoholic hepatitis, although its effectiveness in reducing mortality is unclear 5, 3, 4