VCU-led Study Finds No Difference Among Corticosteroids in Treating Severe Alcohol-Related Hepatitis
Key Findings
- Most patients were middle-aged and about 69% were male.
- Of those treated with corticosteroids, 56% used prednisone, 27.5% used prednisolone, and 14% used methylprednisolone.
- There were no significant differences in survival rates among the three corticosteroids after adjusting for patient factors such as age and liver function (MELD score).
By A.J. Hostetler
A recent international study led by a VCU hepatologist found that three commonly prescribed corticosteroids offer similar outcomes for patients suffering from severe alcohol-associated hepatitis, a life-threatening liver condition linked to prolonged heavy drinking.
Prednisone, prednisolone and methylprednisolone had similar survival outcomes, meaning doctors might have more flexibility to choose a steroid based on availability, cost, or specific patient needs, according to the study, published in the journal Hepatology Communications. The Institute’s director of alcohol sciences, Juan Pablo Arab, M.D., was the paper’s corresponding author.
Severe alcohol-associated hepatitis, or AH, occurs when a person’s heavy alcohol consumption leads to intense inflammation of the liver, causing it to function poorly and putting patients at high risk of serious complications and even death.
Corticosteroids, particularly prednisolone, are widely used to treat patients with severe AH. They reduce liver inflammation, which can improve short-term survival rates. Prednisolone is often preferred because it doesn’t require the liver to process it to start working, making it ideal for patients with severely compromised liver function.
The retrospective study, conducted across 15 international centers, included data from 324 adult patients diagnosed with severe AH. Researchers sought to determine if one of the corticosteroids might be more effective than others at improving patient survival. In the study, 56% of the 324 corticosteroid-treated used prednisone, 27.5% used prednisolone, and 14% used methylprednisolone. Survival rates for each drug were analyzed at 30, 90, and 180 days after hospital admission.
Research has shown that people with a MELD score, a measure of liver function, over 20, but especially between 25 and 39, may have a better chance of survival when treated with corticosteroids.
However, this study found no significant difference for patient survival rates among the three drugs. After accounting for other factors like age, sex, history of cirrhosis, kidney health, and MELD score, all three showed similar effectiveness in improving short-term survival outcomes.
Specifically, the 30-day survival estimates were 79.4% for prednisolone, 90.8% for prednisone, and 82.7% for methylprednisolone.
Researchers noted that age and MELD scores were strong predictors of survival regardless of which corticosteroid was used. This research suggests that, for severe AH, the type of corticosteroid may not matter as much as once thought in terms of survival. This could give doctors more treatment options and flexibility to help patients in different settings.