From the Guidelines
Budesonide is the preferred steroid in cirrhosis due to its high affinity for the glucocorticoid receptor and 90% first-pass metabolism in the liver, which reduces systemic side effects. The use of budesonide in cirrhosis is supported by a study published in Gut in 2011 1, which demonstrated improvement in liver function and inflammation with minimal adverse effects. In patients with cirrhosis, it is essential to carefully evaluate the benefits and risks of steroid therapy, considering factors such as disease severity, potential contraindications, and the need for close monitoring of treatment response and potential complications.
When considering steroid therapy in cirrhosis, the following key points should be taken into account:
- Disease severity should be assessed using scoring systems like Maddrey's discriminant function or MELD score
- Patients should be screened for contraindications including active infection, gastrointestinal bleeding, or renal failure before initiating therapy
- Treatment response should be evaluated after 7 days, with consideration for discontinuation if there's no improvement
- Steroids carry risks of infection, hyperglycemia, and other complications that require close monitoring during treatment.
In contrast to other steroids like prednisolone, budesonide has a more favorable profile in patients with cirrhosis due to its unique pharmacokinetic properties, as noted in the study published in Gut 1. However, the most recent and highest quality evidence should always be consulted to guide clinical decision-making, and other guidelines such as those from the Journal of Hepatology 1 may provide additional context and recommendations for managing patients with cirrhosis.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Steroid of Choice in Cirrhosis
- The choice of steroid in cirrhosis is not explicitly stated in the provided studies, but some studies mention the use of specific steroids in certain contexts.
- For example, a study on the impact of glucocorticoids for cirrhosis patients performed major liver resection found that methylprednisolone used in the preoperative period could degrade the bilirubin and IL-6 level safely and effectively after operation 2.
- Another study on drug choices in autoimmune hepatitis mentions that prednisone and prednisolone are the mainstays of treatment for autoimmune hepatitis, but does not specifically address cirrhosis 3.
- A review article on prescribing medications in patients with cirrhosis provides general guidance on the use of medications in cirrhosis, but does not recommend a specific steroid for use in cirrhosis 4.
- A study on the diagnosis and management of cirrhosis and its complications mentions the use of various medications, including lactulose, carvedilol, and terlipressin, but does not specifically address the use of steroids in cirrhosis 5.
- A study on treatment strategies in autoimmune hepatitis mentions the use of prednisone alone or in combination with azathioprine, but does not specifically address cirrhosis 6.
Key Findings
- Methylprednisolone may be used in the preoperative period to reduce bilirubin and IL-6 levels in cirrhosis patients undergoing major liver resection 2.
- Prednisone and prednisolone are commonly used in the treatment of autoimmune hepatitis, but their use in cirrhosis is not well established 3.
- Medications should be used cautiously in cirrhosis, with consideration of potential hepatotoxicity and altered pharmacokinetics 4.