Are corticosteroids (steroids) effective in the treatment of alcoholic hepatitis?

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Last updated: April 15, 2025 • View editorial policy

From the Guidelines

Steroids are recommended for patients with severe alcoholic hepatitis, as they improve short-term survival, with prednisolone 40 mg/day or methylprednisoline 32 mg/day being the suggested treatment 1. The effectiveness of corticosteroid therapy in severe alcoholic hepatitis has been a subject of controversy, but recent studies have shown that it improves 1-month survival in patients with a severe form of the disease 1.

Key Points to Consider

  • The survival benefit of corticosteroid therapy is significant at 1 month but not at 3 months, highlighting the need for new therapeutic strategies to reduce the risk of death at 3 months 1.
  • The combination of N-acetylcysteine and corticosteroids may offer a short-term survival benefit, but more studies are needed to confirm this 1.
  • Pentoxifylline is no longer recommended due to its ineffectiveness in improving 1-month survival 1.
  • Fast-track liver transplantation should be considered for patients at the end of their therapeutic options, with a rigorous and multidisciplinary selection process 1.

Treatment Approach

  • Patients with severe alcoholic hepatitis should be treated with prednisolone 40 mg/day or methylprednisolone 32 mg/day for 1 month, as recommended by American and European societies 1.
  • The Lille score can be used to assess response to treatment and identify non-responders who may require alternative therapies 1.
  • Abstinence from alcohol is crucial during and after treatment, as continued drinking can negate the benefits of steroids and worsen outcomes.

From the Research

Effectiveness of Steroids in Alcoholic Hepatitis

  • Steroids, such as prednisolone, are commonly used to treat severe alcoholic hepatitis, with studies showing mixed results regarding their effectiveness 2, 3, 4, 5, 6.
  • A meta-analysis of randomized trials found that corticosteroids provided a mortality benefit at 28 days, mainly for liver failure-related death, without increasing the occurrence of or mortality from bacterial infections 2.
  • However, another study found that patients with severe alcoholic hepatitis who received prednisolone were at greater risk for developing serious infections and infections after treatment, which may offset its therapeutic benefit 4.
  • A randomized clinical trial found that the addition of pentoxifylline to prednisolone did not result in improved 6-month survival compared to prednisolone alone 6.

Risks and Complications

  • Steroid treatment has been associated with an increased risk of infections, particularly fungal infections 2, 4.
  • Serious infections, gastrointestinal bleeds, and renal impairment were the most frequently reported adverse events in patients treated with steroids 3.
  • High circulating levels of bacterial DNA have been found to predict infection in patients treated with prednisolone 4.

Treatment Recommendations

  • The timing of steroid initiation, tapering regimens, and surveillance of adverse events are crucial in the management of severe alcoholic hepatitis 3.
  • A systematic review of randomized controlled trials recommended taking up to a week to evaluate patients before initiating steroids and vigilant monitoring in the first month of treatment 3.
  • The use of the lowest possible steroid exposure with a two-week steroid taper and close outpatient follow-up is also recommended 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.