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Antioxidants and severe alcoholic hepatitis
Antioxidants and severe alcoholic hepatitis
J Hepatol. 2007 May 4; [Epub ahead of print]
A randomized trial of antioxidant therapy alone or with
corticosteroids in acute alcoholic hepatitis
Stewart S, Prince M, Bassendine M, Hudson M, James O, Jones D, Record
C, Day CP.
Liver Research Group, Institute of Cellular Medicine, Medical School,
Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
BACKGROUND/AIMS:
Oxidative stress is putatively involved in the pathogenesis of alcohol-
induced liver injury. This trial was devised to determine whether
antioxidant therapy, alone or as an adjunct to corticosteroids,
improved survival in patients with acute alcoholic hepatitis.
METHODS:
Patients with a severe alcoholic hepatitis were stratified by sex and
steroid use, and then randomized. The active group received N-
acetylcysteine for one week, and vitamins A-E, biotin, selenium, zinc,
manganese, copper, magnesium, folic acid and Coenzyme Q daily for 6
months. The trial was double blinded and placebo controlled. The
primary end-point was mortality within 6 months.
RESULTS:
Thirty-six (20 male, 16 female; mean DF 86.6) received active drug,
and 34 (18 male, 16 female; mean discriminant function (DF) 76.4)
received placebo. 180-day survival was not significantly different
between patients receiving drug and placebo (52.8% vs. 55.8%,
p=0.699). This was not affected by stratification for steroid use or
sex. The only predictors of survival in multivariate analysis were
initial bilirubin (p=0.017), white cell count (p=0.016) and age
(p=0.037). Treatment allocation did not affect survival in
multivariate analysis (p=0.830).
CONCLUSIONS:
Antioxidant therapy, alone or in combination with corticosteroids,
does not improve 6-month survival in severe alcoholic hepatitis.
PMID: 17532088 [PubMed - as supplied by publisher]
---------------------------------------------------------------------------------
* tinyurl . com /25k7kc
WHEREAS .. using a drug / Pentoxifylline which is KNOWN to lower red
blood cell count .. the equivalent to bloodletting / phlebotomy ..
GETS .. "good results" / improved nondeath .. rate ..
50% .. decreased .. death ..
Hmmm ..
Gastroenterology. 2000 Dec;119(6):1637-48. Links
Comment in:
ACP J Club. 2001 Jul-Aug;135(1):4.
Gastroenterology. 2000 Dec;119(6):1787-91.
Pentoxifylline improves short-term survival in severe acute alcoholic
hepatitis: a double-blind, placebo-controlled trial.Akriviadis E,
Botla R, Briggs W, Han S, Reynolds T, Shakil O.
Liver Unit, University of Southern California, Rancho Los Amigos
Medical Center, Downey, California.
BACKGROUND & AIMS: An earlier pilot study from our liver unit
suggested benefit from treatment with pentoxifylline (PTX), an
inhibitor of tumor necrosis factor (TNF), in severe acute alcoholic
hepatitis. The aim of the present study was to evaluate this treatment
in a larger cohort of patients. METHODS: One hundred one patients with
severe alcoholic hepatitis (Maddrey discriminant factor > or = 32)
entered a 4-week double-blind randomized trial of PTX (400 mg orally 3
times daily) vs. placebo. Primary endpoints of the study were the
effect of PTX on (1) short-term survival and (2) progression to
hepatorenal syndrome. On randomization, there were no differences in
demographic and clinical characteristics or laboratory values
(including TNF) between the 2 groups. RESULTS: Twelve (24.5%) of the
49 patients who received PTX and 24 (46.1%) of the 52 patients who
received placebo died during the index hospitalization (P = 0.037;
relative risk, 0.59; 95% confidence interval, 0.35-0.97). Hepatorenal
syndrome was the cause of death in 6 (50%) and 22 (91.7%) patients (P
= 0.009; relative risk, 0.29; 95% confidence interval, 0.13-0.65).
Three variables (age, creatinine level on randomization, and treatment
with PTX) were independently associated with survival. TNF values on
randomization were not predictive of survival; however, during the
study period they increased markedly in nonsurvivors compared with
survivors in both groups. CONCLUSIONS: Treatment with PTX improves
short-term survival in patients with severe alcoholic hepatitis. The
benefit appears to be related to a significant decrease in the risk of
developing hepatorenal syndrome. Increasing TNF levels during the
hospital course are associated with an increase in mortality rate.
PMID: 11113085 [PubMed - indexed for MEDLINE]
Who loves ya.
Tom
Jesus Was A Vegetarian!
* jesuswasavegetarian.7h . com
Man Is A Herbivore!
* tinyurl . com /a3cc3
DEAD PEOPLE WALKING
* tinyurl . com /zk9fk
J Hepatol. 2007 May 4; [Epub ahead of print]
A randomized trial of antioxidant therapy alone or with
corticosteroids in acute alcoholic hepatitis
Stewart S, Prince M, Bassendine M, Hudson M, James O, Jones D, Record
C, Day CP.
Liver Research Group, Institute of Cellular Medicine, Medical School,
Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
BACKGROUND/AIMS:
Oxidative stress is putatively involved in the pathogenesis of alcohol-
induced liver injury. This trial was devised to determine whether
antioxidant therapy, alone or as an adjunct to corticosteroids,
improved survival in patients with acute alcoholic hepatitis.
METHODS:
Patients with a severe alcoholic hepatitis were stratified by sex and
steroid use, and then randomized. The active group received N-
acetylcysteine for one week, and vitamins A-E, biotin, selenium, zinc,
manganese, copper, magnesium, folic acid and Coenzyme Q daily for 6
months. The trial was double blinded and placebo controlled. The
primary end-point was mortality within 6 months.
RESULTS:
Thirty-six (20 male, 16 female; mean DF 86.6) received active drug,
and 34 (18 male, 16 female; mean discriminant function (DF) 76.4)
received placebo. 180-day survival was not significantly different
between patients receiving drug and placebo (52.8% vs. 55.8%,
p=0.699). This was not affected by stratification for steroid use or
sex. The only predictors of survival in multivariate analysis were
initial bilirubin (p=0.017), white cell count (p=0.016) and age
(p=0.037). Treatment allocation did not affect survival in
multivariate analysis (p=0.830).
CONCLUSIONS:
Antioxidant therapy, alone or in combination with corticosteroids,
does not improve 6-month survival in severe alcoholic hepatitis.
PMID: 17532088 [PubMed - as supplied by publisher]
---------------------------------------------------------------------------------
* tinyurl . com /25k7kc
WHEREAS .. using a drug / Pentoxifylline which is KNOWN to lower red
blood cell count .. the equivalent to bloodletting / phlebotomy ..
GETS .. "good results" / improved nondeath .. rate ..
50% .. decreased .. death ..
Hmmm ..
Gastroenterology. 2000 Dec;119(6):1637-48. Links
Comment in:
ACP J Club. 2001 Jul-Aug;135(1):4.
Gastroenterology. 2000 Dec;119(6):1787-91.
Pentoxifylline improves short-term survival in severe acute alcoholic
hepatitis: a double-blind, placebo-controlled trial.Akriviadis E,
Botla R, Briggs W, Han S, Reynolds T, Shakil O.
Liver Unit, University of Southern California, Rancho Los Amigos
Medical Center, Downey, California.
BACKGROUND & AIMS: An earlier pilot study from our liver unit
suggested benefit from treatment with pentoxifylline (PTX), an
inhibitor of tumor necrosis factor (TNF), in severe acute alcoholic
hepatitis. The aim of the present study was to evaluate this treatment
in a larger cohort of patients. METHODS: One hundred one patients with
severe alcoholic hepatitis (Maddrey discriminant factor > or = 32)
entered a 4-week double-blind randomized trial of PTX (400 mg orally 3
times daily) vs. placebo. Primary endpoints of the study were the
effect of PTX on (1) short-term survival and (2) progression to
hepatorenal syndrome. On randomization, there were no differences in
demographic and clinical characteristics or laboratory values
(including TNF) between the 2 groups. RESULTS: Twelve (24.5%) of the
49 patients who received PTX and 24 (46.1%) of the 52 patients who
received placebo died during the index hospitalization (P = 0.037;
relative risk, 0.59; 95% confidence interval, 0.35-0.97). Hepatorenal
syndrome was the cause of death in 6 (50%) and 22 (91.7%) patients (P
= 0.009; relative risk, 0.29; 95% confidence interval, 0.13-0.65).
Three variables (age, creatinine level on randomization, and treatment
with PTX) were independently associated with survival. TNF values on
randomization were not predictive of survival; however, during the
study period they increased markedly in nonsurvivors compared with
survivors in both groups. CONCLUSIONS: Treatment with PTX improves
short-term survival in patients with severe alcoholic hepatitis. The
benefit appears to be related to a significant decrease in the risk of
developing hepatorenal syndrome. Increasing TNF levels during the
hospital course are associated with an increase in mortality rate.
PMID: 11113085 [PubMed - indexed for MEDLINE]
Who loves ya.
Tom
Jesus Was A Vegetarian!
* jesuswasavegetarian.7h . com
Man Is A Herbivore!
* tinyurl . com /a3cc3
DEAD PEOPLE WALKING
* tinyurl . com /zk9fk
