Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids
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 cort...
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| Veröffentlicht in: | Journal of hepatology 2008-03, Vol.48 (3), p.465-470 |
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| container_title | Journal of hepatology |
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| creator | Louvet, Alexandre Diaz, Emmanuel Dharancy, Sébastien Coevoet, Hugues Texier, Frédéric Thévenot, Thierry Deltenre, Pierre Canva, Valérie Plane, Christophe Mathurin, Philippe |
| description | 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 (−0.25 s vs +0.2 s), 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. |
| doi_str_mv | 10.1016/j.jhep.2007.10.010 |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_00515739v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827807005934</els_id><sourcerecordid>S0168827807005934</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-1762e13d9a3430d94456e2161e114c2a6b4de35176378a57091800092ac3d4553</originalsourceid><addsrcrecordid>eNp9ks9rFDEUx4Modq3-Ax4kFw8eZn1vkvkREKGU1goLHtRzSDNvmIzTyZBMt-7Fv70Ju1TwIAQCj8_3veSTMPYWYYuA9cdxOw60bEuAJhW2gPCMbbAGKKCW-JxtEtQWbdm0Z-xVjCMACFDyJTvDFmtZQbthf65MmA48PrjVDnz1fKF59b9df5gmNxN3M1_M6lIx8sQMPNKeAnEzWT_4yVmejpCA1UWe10x972zmc3T2cxEoLn7uKMTc3vqwOuvjSsG7Lr5mL3ozRXpz2s_Zz-urH5c3xe7bl6-XF7vCSqXWApu6JBSdMkIK6JSUVU0l1kiI0pamvpUdiSphomlN1YDCNt1WlcaKTlaVOGcfjn0HM-kluDsTDtobp28udjrXACqsGqH2mNjyyNrgYwzUPwUQdBavR53F6yw-15L4FHp3DC33t3fU_Y2cTCfg_Qkw0ZqpD2a2Lj5xJaAUSuXpn44cJR17R0HHrNNS5wLZVXfe_f8cn_-J2_SOLk38RQeKo78PcxKtUcdSg_6ev0j-IdAkAyrZfQT9MLbF</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Louvet, Alexandre ; Diaz, Emmanuel ; Dharancy, Sébastien ; Coevoet, Hugues ; Texier, Frédéric ; Thévenot, Thierry ; Deltenre, Pierre ; Canva, Valérie ; Plane, Christophe ; Mathurin, Philippe</creator><creatorcontrib>Louvet, Alexandre ; Diaz, Emmanuel ; Dharancy, Sébastien ; Coevoet, Hugues ; Texier, Frédéric ; Thévenot, Thierry ; Deltenre, Pierre ; Canva, Valérie ; Plane, Christophe ; Mathurin, Philippe</creatorcontrib><description>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 (−0.25 s vs +0.2 s), 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.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2007.10.010</identifier><identifier>PMID: 18164508</identifier><identifier>CODEN: JOHEEC</identifier><language>eng</language><publisher>Oxford: Elsevier B.V</publisher><subject>Adrenal Cortex Hormones ; Adrenal Cortex Hormones - therapeutic use ; Adult ; Aged ; Alcoholic hepatitis ; Bilirubin ; Bilirubin - blood ; Biological and medical sciences ; Bones, joints and connective tissue. Antiinflammatory agents ; Cohort Studies ; Corticosteroids ; Creatinine ; Creatinine - blood ; Drug Resistance ; Female ; Free Radical Scavengers ; Free Radical Scavengers - therapeutic use ; Gastroenterology and Hepatology ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatitis, Alcoholic ; Hepatitis, Alcoholic - blood ; Hepatitis, Alcoholic - drug therapy ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Life Sciences ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Non-response ; Other diseases. Semiology ; Pentoxifylline ; Pentoxifylline - therapeutic use ; Pharmacology. Drug treatments ; Prednisolone ; Prednisolone - therapeutic use ; Proportional Hazards Models ; Prospective Studies ; Prothrombin Time ; Survival Analysis ; Treatment Outcome</subject><ispartof>Journal of hepatology, 2008-03, Vol.48 (3), p.465-470</ispartof><rights>European Association for the Study of the Liver</rights><rights>2007 European Association for the Study of the Liver</rights><rights>2008 INIST-CNRS</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-1762e13d9a3430d94456e2161e114c2a6b4de35176378a57091800092ac3d4553</citedby><cites>FETCH-LOGICAL-c499t-1762e13d9a3430d94456e2161e114c2a6b4de35176378a57091800092ac3d4553</cites><orcidid>0000-0002-5293-007X ; 0000-0002-4253-6028 ; 0000-0003-3447-2025</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhep.2007.10.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,315,782,786,887,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20143991$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18164508$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-00515739$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Louvet, Alexandre</creatorcontrib><creatorcontrib>Diaz, Emmanuel</creatorcontrib><creatorcontrib>Dharancy, Sébastien</creatorcontrib><creatorcontrib>Coevoet, Hugues</creatorcontrib><creatorcontrib>Texier, Frédéric</creatorcontrib><creatorcontrib>Thévenot, Thierry</creatorcontrib><creatorcontrib>Deltenre, Pierre</creatorcontrib><creatorcontrib>Canva, Valérie</creatorcontrib><creatorcontrib>Plane, Christophe</creatorcontrib><creatorcontrib>Mathurin, Philippe</creatorcontrib><title>Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>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 (−0.25 s vs +0.2 s), 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.</description><subject>Adrenal Cortex Hormones</subject><subject>Adrenal Cortex Hormones - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Alcoholic hepatitis</subject><subject>Bilirubin</subject><subject>Bilirubin - blood</subject><subject>Biological and medical sciences</subject><subject>Bones, joints and connective tissue. Antiinflammatory agents</subject><subject>Cohort Studies</subject><subject>Corticosteroids</subject><subject>Creatinine</subject><subject>Creatinine - blood</subject><subject>Drug Resistance</subject><subject>Female</subject><subject>Free Radical Scavengers</subject><subject>Free Radical Scavengers - therapeutic use</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatitis, Alcoholic</subject><subject>Hepatitis, Alcoholic - blood</subject><subject>Hepatitis, Alcoholic - drug therapy</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Life Sciences</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Non-response</subject><subject>Other diseases. Semiology</subject><subject>Pentoxifylline</subject><subject>Pentoxifylline - therapeutic use</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisolone</subject><subject>Prednisolone - therapeutic use</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Prothrombin Time</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9rFDEUx4Modq3-Ax4kFw8eZn1vkvkREKGU1goLHtRzSDNvmIzTyZBMt-7Fv70Ju1TwIAQCj8_3veSTMPYWYYuA9cdxOw60bEuAJhW2gPCMbbAGKKCW-JxtEtQWbdm0Z-xVjCMACFDyJTvDFmtZQbthf65MmA48PrjVDnz1fKF59b9df5gmNxN3M1_M6lIx8sQMPNKeAnEzWT_4yVmejpCA1UWe10x972zmc3T2cxEoLn7uKMTc3vqwOuvjSsG7Lr5mL3ozRXpz2s_Zz-urH5c3xe7bl6-XF7vCSqXWApu6JBSdMkIK6JSUVU0l1kiI0pamvpUdiSphomlN1YDCNt1WlcaKTlaVOGcfjn0HM-kluDsTDtobp28udjrXACqsGqH2mNjyyNrgYwzUPwUQdBavR53F6yw-15L4FHp3DC33t3fU_Y2cTCfg_Qkw0ZqpD2a2Lj5xJaAUSuXpn44cJR17R0HHrNNS5wLZVXfe_f8cn_-J2_SOLk38RQeKo78PcxKtUcdSg_6ev0j-IdAkAyrZfQT9MLbF</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>Louvet, Alexandre</creator><creator>Diaz, Emmanuel</creator><creator>Dharancy, Sébastien</creator><creator>Coevoet, Hugues</creator><creator>Texier, Frédéric</creator><creator>Thévenot, Thierry</creator><creator>Deltenre, Pierre</creator><creator>Canva, Valérie</creator><creator>Plane, Christophe</creator><creator>Mathurin, Philippe</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-5293-007X</orcidid><orcidid>https://orcid.org/0000-0002-4253-6028</orcidid><orcidid>https://orcid.org/0000-0003-3447-2025</orcidid></search><sort><creationdate>20080301</creationdate><title>Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids</title><author>Louvet, Alexandre ; Diaz, Emmanuel ; Dharancy, Sébastien ; Coevoet, Hugues ; Texier, Frédéric ; Thévenot, Thierry ; Deltenre, Pierre ; Canva, Valérie ; Plane, Christophe ; Mathurin, Philippe</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-1762e13d9a3430d94456e2161e114c2a6b4de35176378a57091800092ac3d4553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adrenal Cortex Hormones</topic><topic>Adrenal Cortex Hormones - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Alcoholic hepatitis</topic><topic>Bilirubin</topic><topic>Bilirubin - blood</topic><topic>Biological and medical sciences</topic><topic>Bones, joints and connective tissue. Antiinflammatory agents</topic><topic>Cohort Studies</topic><topic>Corticosteroids</topic><topic>Creatinine</topic><topic>Creatinine - blood</topic><topic>Drug Resistance</topic><topic>Female</topic><topic>Free Radical Scavengers</topic><topic>Free Radical Scavengers - therapeutic use</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatitis, Alcoholic</topic><topic>Hepatitis, Alcoholic - blood</topic><topic>Hepatitis, Alcoholic - drug therapy</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Life Sciences</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Non-response</topic><topic>Other diseases. Semiology</topic><topic>Pentoxifylline</topic><topic>Pentoxifylline - therapeutic use</topic><topic>Pharmacology. Drug treatments</topic><topic>Prednisolone</topic><topic>Prednisolone - therapeutic use</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Prothrombin Time</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Louvet, Alexandre</creatorcontrib><creatorcontrib>Diaz, Emmanuel</creatorcontrib><creatorcontrib>Dharancy, Sébastien</creatorcontrib><creatorcontrib>Coevoet, Hugues</creatorcontrib><creatorcontrib>Texier, Frédéric</creatorcontrib><creatorcontrib>Thévenot, Thierry</creatorcontrib><creatorcontrib>Deltenre, Pierre</creatorcontrib><creatorcontrib>Canva, Valérie</creatorcontrib><creatorcontrib>Plane, Christophe</creatorcontrib><creatorcontrib>Mathurin, Philippe</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Louvet, Alexandre</au><au>Diaz, Emmanuel</au><au>Dharancy, Sébastien</au><au>Coevoet, Hugues</au><au>Texier, Frédéric</au><au>Thévenot, Thierry</au><au>Deltenre, Pierre</au><au>Canva, Valérie</au><au>Plane, Christophe</au><au>Mathurin, Philippe</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>48</volume><issue>3</issue><spage>465</spage><epage>470</epage><pages>465-470</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><coden>JOHEEC</coden><abstract>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 (−0.25 s vs +0.2 s), 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.</abstract><cop>Oxford</cop><pub>Elsevier B.V</pub><pmid>18164508</pmid><doi>10.1016/j.jhep.2007.10.010</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5293-007X</orcidid><orcidid>https://orcid.org/0000-0002-4253-6028</orcidid><orcidid>https://orcid.org/0000-0003-3447-2025</orcidid></addata></record> |
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| subjects | Adrenal Cortex Hormones Adrenal Cortex Hormones - therapeutic use Adult Aged Alcoholic hepatitis Bilirubin Bilirubin - blood Biological and medical sciences Bones, joints and connective tissue. Antiinflammatory agents Cohort Studies Corticosteroids Creatinine Creatinine - blood Drug Resistance Female Free Radical Scavengers Free Radical Scavengers - therapeutic use Gastroenterology and Hepatology Gastroenterology. Liver. Pancreas. Abdomen Hepatitis, Alcoholic Hepatitis, Alcoholic - blood Hepatitis, Alcoholic - drug therapy Human health and pathology Humans Hépatology and Gastroenterology Life Sciences Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Multivariate Analysis Non-response Other diseases. Semiology Pentoxifylline Pentoxifylline - therapeutic use Pharmacology. Drug treatments Prednisolone Prednisolone - therapeutic use Proportional Hazards Models Prospective Studies Prothrombin Time Survival Analysis Treatment Outcome |
| title | Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids |
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