English

Abstract

BACKGROUND Proven therapeutic options for treating severe alcoholic hepatitis are limited. The study was conducted to compare pentoxifylline alone versus combination of Pentoxifylline plus N acetylcysteine in severe alcoholic hepatitis patients. METHODS A randomised, parallel, double blind, active controlled trial was conducted in which, 240 cases were considered for analysis and were divided into two study groups i.e. tablet pentoxifylline alone versus tablet pentoxifylline plus tablet N acetylcysteine. The pentoxifylline group received 400 mg thrice daily for one month and the other group received tablet pentoxifylline 400 mg thrice daily with tablet N–acetyl cysteine 600 mg twice daily for one month. Enrolled patients were called for follow up at one and three months. The parameters were compared between the two study groups statistically and the results were obtained. RESULTS Forty-nine (20.4 %) patients expired in 3 months, out of which 35 (14.5 %) expired at the end of 1st month. There was no significant difference in survival between two groups at the end of one and three months (P = 0.58 and 0.10 respectively). Although liver function test (LFT), PT-INR (prothrombin timeinternational normalised ratio) improved significantly from baseline in both the groups (P < 0.0001), no significant difference was observed between the two groups. Prevalence of hepatic encephalopathy was significantly low in pentoxifylline plus N-acetylcysteine group at one and three months (P = 0.04 and 0.02 respectively). CONCLUSIONS Addition of N acetyl cysteine to pentoxifylline helps in reducing hepatic encephalopathy in patients with severe alcoholic hepatitis; however, it does not improve the short-term survival. KEYWORDS Pentoxifylline, N-acetylcysteine, Alcoholic Hepatitis, Liver Disorder