Corticosteroids in severe alcohol-associated hepatitis. Not so fast: A systematic review of randomized controlled trials

作者：Michael Shi, Prisca Pungwe, Lauren L. Comer, Maya Balakrishnan, Tzu‐Hao Lee, George Cholankeril, Kavish R. Patidar, Avegail Flores, Vijay H. Shah, Ramon Bataller, Sumeet K. Asrani, Juan Pablo Arab, Fasiha Kanwal, Rubén Hernáez · 发表于：Hepatology · 年份：2025 · DOI：10.1097/hep.0000000000001237 · 被引用次数：5 · 研究领域：Alcohol Consumption and Health Effects、Liver Disease and Transplantation、Drug-Induced Hepatotoxicity and Protection

BACKGROUND AND AIMS: Severe alcohol-associated hepatitis (AH) is rising in incidence with a high mortality burden. While corticosteroids are recommended for eligible patients with severe AH, no guidance exists for the timing of steroid initiation, tapering regimens, and surveillance of adverse events. We aim to systematically review these variables and provide evidence-based recommendations for the inpatient and outpatient management of severe AH. APPROACH AND RESULTS: We performed a literature search from inception to May 30, 2024, to include clinical trials published in full form and assessed the quality of evidence using the Cochrane Risk of Bias tool. Data were collected on the timing of initiation, rate, and complications following steroid therapy, and taper regimens in the setting of severe AH. Of 28 studies that fulfilled our inclusion criteria, the median time from admission to steroid initiation was 6.5 days. The most common steroid dosing regimen was prednisolone 40 mg daily for 28 days. Twenty-five studies containing 3196 subjects reported adverse events, with exactly 50% in the steroid arm and the other half in the comparison arm. Infections, gastrointestinal bleeds, and renal impairment were the most frequently reported adverse events. Most infections occurred within the first month of the study. A 2-week steroid taper was the most frequently reported regimen. CONCLUSIONS: We recommend taking up to a week to systematically and thoroughly evaluate patients before ...