Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids

J Hepatol. 2008 Mar;48(3):465-70. doi: 10.1016/j.jhep.2007.10.010. Epub 2007 Nov 26.


Background/aims: In severe alcoholic hepatitis (AH), 40% of patients will obtain no benefit from corticosteroids. Improvement in management of non-responders is warranted and only pentoxifylline can be considered an alternative. A two-step strategy was evaluated consisting of early withdrawal of corticosteroids and a switch to pentoxifylline for 28 additional days in non-responders identified using early change in bilirubin level.

Methods: One hundred and twenty-one patients with AH were treated prospectively with corticosteroids, and the two-step strategy was proposed to 29 non-responders treated according to a two-step strategy who were compared to 58 matched non-responders treated with corticosteroids only.

Results: Clinical and biological features of the two groups were similar. There was no survival improvement at 2 months in patients treated with the two-step strategy compared to controls: 35.5+/-6.3% vs 31+/-8.6%. After 21 days, biological evolution was similar for prothrombin time (-0.25s vs +0.2s), bilirubin (0.8 mg/dl vs 2.03 mg/dl) and creatinine (+0.16 mg/dl vs -0.7 mg/dl). In multivariate analysis, only age, evolution of bilirubin during the first week, creatinine and DF were associated with 2-month survival.

Conclusions: Non-responders to corticosteroids do not obtain any benefit from an early switch to pentoxifylline. Thus, the issue of management of non-responders remains unresolved.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Bilirubin / blood
  • Cohort Studies
  • Creatinine / blood
  • Drug Resistance
  • Female
  • Free Radical Scavengers / therapeutic use*
  • Hepatitis, Alcoholic / blood
  • Hepatitis, Alcoholic / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pentoxifylline / therapeutic use*
  • Prednisolone / therapeutic use*
  • Proportional Hazards Models
  • Prospective Studies
  • Prothrombin Time
  • Survival Analysis
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Free Radical Scavengers
  • Prednisolone
  • Creatinine
  • Bilirubin
  • Pentoxifylline