Pentoxifylline Ineffective in Alcoholic Hepatitis With AKI
Pentoxifylline, an anti–tumor necrosis factor alpha agent, did not improve survival outcomes in patients with severe alcohol-associated hepatitis complicated by acute kidney injury (AKI).
METHODOLOGY:
Severe alcohol-associated hepatitis is a life-threatening condition with corticosteroid treatment as the only therapy demonstrating short-term benefits, leading to the investigation of potential alternative therapies, such as pentoxifylline, particularly for patients having from AKI.
Researchers conducted a retrospective cohort study to examine the effect of pentoxifylline on mortality outcomes in patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for severe alcohol-associated hepatitis and AKI.
The study included 525 patients (median age, 48 years; 26.1% women) from 20 centers across eight countries; participants were divided into two groups: The pentoxifylline group (n = 47) and the control group (n = 478).
The primary endpoint was time to death, with liver transplantation considered a competing event.
TAKEAWAY:
Survival rates were comparable between the pentoxifylline and control groups at all timepoints: Day 30 (63.8% vs 63.7%), day 90 (46.2% vs 49.8%), and day 180 (39.6% vs 45.6%).
Pentoxifylline use was not significantly associated with an increased risk for death ( P = .291); however, older age, higher Model for End-Stage Liver Disease scores at admission, and the use of renal replacement therapy were significantly associated with an increased risk for mortality ( P < .02 for all).
= .291); however, older age, higher Model for End-Stage Liver Disease scores at admission, and the use of renal replacement therapy were significantly associated with an increased risk for mortality ( < .02 for all). An exploratory analysis focused on patients with more severe AKI (defined as having creatinine levels of ≥ 1.5 mg/dL) also showed similar results.
The main causes of death in both groups were multiple organ failure, infections, esophageal variceal bleeding, and renal failure.
IN PRACTICE:
'Pentoxifylline showed no significant benefit on mortality in patients with sAH [severe alcohol-associated hepatitis] and AKI,' the authors concluded, noting that 'further studies are needed to refine treatment strategies for this high-risk group.'
SOURCE:
This study was led by Francisco Idalsoaga, Pontificia Universidad Católica de Chile, Santiago, Chile, and was published online in eGastroenterology .
LIMITATIONS:
The retrospective nature of this study may have introduced selection bias. This study could not evaluate the degree of alcohol abstinence achieved following hospitalization or include information on the initiation of therapy for alcohol use disorder, both of which could have influenced long-term outcomes. The lack of data on the exact duration and timing of pentoxifylline treatment further limited the interpretation of findings.
DISCLOSURES:
One author reported receiving financial support from the Chilean government through the Fondo Nacional de Desarrollo Cientifico y Tecnológico. One author reported being an editorial board member of eGastroenterology .
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