Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial

R. L. Carithers, F. Herlong, A. M. Diehl, E. W. Shaw, B. Combes, H. J. Fallon, W. C. Maddrey

Research output: Contribution to journalArticle

369 Scopus citations

Abstract

Study Objective: To determine the efficacy of a corticosteroid in reducing the short-term mortality of patients with severe alcoholic hepatitis. Design: Randomized, double-blind, placebo-controlled multicenter trial. Setting: Four university teaching hospitals. Patients: We enrolled 66 patients with alcoholic hepatitis and either spontaneous hepatic encephalopathy or a discriminant function value greater than 32, calculated using the formula: 4.6(prothrombin time - control time) + serum bilirubin [in μmol/L]/17.1. Fifty-nine patients (89%) completed the study. Two patients withdrew from the trial. The other 64 patients were hospitalized for the duration of the trial; however, treatment was discontinued in 5 patients because of potential drug toxicity. Interventions: Patients were randomly assigned to receive either methylprednisolone (32 mg) or placebo within 7 days of admission. Treatment was given for 28 days. The doses were then tapered over 2 weeks and discontinued. Measurements and Main Results: The endpoint of the study was death. Of the 31 recipients of placebo, 11 (35%) died within 28 days of randomization compared with 2 (6%) of the 35 patients given methylprednisolone (P = 0.006). The 95% CI for the difference in mortality was 12% to 70%. In the patients with spontaneous hepatic encephalopathy at entry, 9 of 19 recipients of placebo died (47%) compared with 1 (7%) of the 14 patients given methylprednisolone (P = 0.02). The 95% CI for the difference in mortality was 14% to 66%. The Cox proportional hazards regression model showed the advantage of methylprednisolone over placebo after adjustment for other potentially important prognostic variables (P = 0.004). Conclusions: Methylprednisolone therapy decreases short-term mortality in patients with severe alcoholic hepatitis manifested either by spontaneous hepatic encephalopathy or a markedly elevated discriminant function value.

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalAnnals of internal medicine
Volume110
Issue number9
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial'. Together they form a unique fingerprint.

  • Cite this