Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial

World J Gastroenterol. 2009 Apr 7;15(13):1613-9. doi: 10.3748/wjg.15.1613.


Aim: To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis, and to evaluate the role of different liver function scores in predicting prognosis.

Methods: Sixty-eight patients with severe alcoholic hepatitis (Maddrey score > or = 32) received pentoxifylline (n = 34, group I) or prednisolone (n = 34, group II) for 28 d in a randomized double-blind controlled study, and subsequently in an open study (with a tapering dose of prednisolone) for a total of 3 mo, and were followed up over a period of 12 mo.

Results: Twelve patients in group II died at the end of 3 mo in contrast to five patients in group I. The probability of dying at the end of 3 mo was higher in group II as compared to group I (35.29% vs 14.71%, P = 0.04; log rank test). Six patients in group II developed hepatorenal syndrome as compared to none in group I. Pentoxifylline was associated with a significantly lower model for end-stage liver disease (MELD) score at the end of 28 d of therapy (15.53 +/- 3.63 vs 17.78 +/- 4.56, P = 0.04). Higher baseline Maddrey score was associated with increased mortality.

Conclusion: Reduced mortality, improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Double-Blind Method
  • Female
  • Hepatitis, Alcoholic / drug therapy*
  • Hepatitis, Alcoholic / mortality
  • Hepatitis, Alcoholic / pathology
  • Hepatitis, Alcoholic / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Pentoxifylline / therapeutic use*
  • Phosphodiesterase Inhibitors / therapeutic use*
  • Prednisolone / therapeutic use*
  • Survival Rate


  • Anti-Inflammatory Agents
  • Phosphodiesterase Inhibitors
  • Prednisolone
  • Pentoxifylline