Prednisolone plus S-adenosil-L-methionine in severe alcoholic hepatitis.

Abstract

Severe alcoholic hepatitis (AH) is a life-threatening liver disease with a potential of 30-40% mortality at 1month. While steroids remain to be a first line therapy, they provide only about 50% survival benefit. The aim of the study was to evaluate the efficacy of glucocorticoids plus S-adenosylmethionine (SAMe), as compared to glucocorticoids alone, in patients with severe alcoholic hepatitis. Forty patients with severe AH were randomized in two groups and enrolled in the prospective trial. Group 1 (n=20) patients received prednisolone 40mg/daily per os, and group 2 (n=20) patients were managed with prednisolone 40mg/daily per os plus SAMe 800mg i.v. Duration was 28days. The response rate assessed by Lille model was significantly higher in the prednisolone plus SAMe group (19 of 20; 95%) than in the prednisolone group (13 of 20; 65%), p=0.044. Two (10%) patients died, both from the prednisolone group. There were no lethal outcomes in the prednisolone plus SAMe group. The Kaplan-Meier method showed no significant differences between the two groups (p=0.151, log-rank). Hepatorenal syndrome (HRS) occurred in 20% in the prednisolone group (4 of 20 patients) while no HRS cases were registered in the prednisolone plus SAMe group (p=0.035). Management of severe alcoholic hepatitis with prednisolone plus SAMe was associated with better therapy response (p=0.044) and less frequent HRS occurrence (p=0.035). Mortality was not significantly lower in the prednisolone-SAMe group than in the prednisolone-only group at 28days (10 vs. 0%, p=0.151).