Pentoxifylline in the Treatment of Acute Alcoholic Hepatitis

Abstract

Background/Aim: It has recently been reported that treatment with pentoxifylline, an inhibitor of tumour necrosis factor, improves survival in severe alcoholic hepatitis. The present study was initiated to test the hypothesis that pentoxifylline improves short term survival in patients with acute alcoholic hepatitis in Indian scenario. Materials and Methods: Single center prospective observational study. We evaluated patients diagnosed with alcoholic hepatitis who were admitted to our hospitals from September 2008 to September 2010. Patients with history of chronic alcohol intake or a recent alcoholic binge, Jaundice and one or more of the following clinical and laboratory findings: palpable tender hepatomegaly, Leucocytosis, hepatic encephalopathy and AST:ALT ratio>2 with absolute values of AST < 500 IU/L and ALT < 200 IU/L were included in the study. Patients with gastrointestinal hemorrhage and other possible causes of hepatitis were excluded. Results: Twenty of the 49 patients were treated with pentoxifylline. Pentoxyfylline treatment did not affect mortality significantly (p = 0.081). However, treatment with pentoxyfylline in those with severe alcoholic hepatitis with DF≥32, MELD score≥21 and GAHS ≥9 significantly reduced mortality (p=0.037, 0.025, 0.001 respectively). Baseline bilirubin, creatinine, urea, MELD score and GAHS were significantly high among the patients who succumbed to the disease as compared to those who survived. Conclusion: Patients with severe alcoholic hepatitis (Maddrey’s discriminant function ≥32; or MELD score ≥21: or GAHS ≥9), can be treated with pentoxifylline, as it is safe, economical, and appears to be useful in improving short term mortality, especially in the Indian scenario.