Clinical inquiries. How does pentoxifylline affect survival of patients with alcoholic hepatitis?

Decreases in mortality and hepatorenal syndrome In a hospital-based clinical trial, 101 patients admitted with severe alcoholic hepatitis (mean age 42 years, 74% men) were randomized to oral pentoxifylline 400 mg twice a day or placebo (vitamin B12 tablets) for 4 weeks. 1 The main outcome measures were short-term survival and progression to hepatorenal syndrome. Severe alcoholic hepatitis was defi ned as a Maddrey discriminant factor (DF) >32, jaundice, and at least one of the following: tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit. The DF is calculated as follows: 4.6 × [prothrombin time in seconds – control time] + bilirubin (mg/dL). Medical management was “individualized according to each patient’s condition.” Pentoxifylline therapy was associated with decreased mortality during the index hospitalization (relative risk [RR]=0.59; 95% confi dence interval [CI], 0.35-0.97; number needed to treat [NNT]=5). Hepatorenal syndrome also decreased (RR=0.29; 95% CI, 0.130.65; NNT=4). Patients in the pentoxifylline group tended to have more headaches and gastrointestinal side effects, but no other serious health hazards were observed. In a recently published abstract, 50 patients with severe alcoholic hepatitis (defi ned as DF >32) were enrolled in a randomized, double-blind, placebocontrolled trial of oral pentoxifylline, 400 mg twice a day or placebo for 4 weeks.2 Short-term survival and changes in laboratory values (TNF, creatinine, and DF) were the primary outcome measures. Survival was 76% in the pentoxifylline group compared with 60% in the How does pentoxifylline affect survival of patients with alcoholic hepatitis?