Epistemonikos summaries
← vista completaPublished on July 29, 2014 | http://doi.org/10.5867/medwave.2014.06.6002
Is pentoxifylline effective in alcoholic hepatitis?
¿Es efectiva la pentoxifilina en hepatitis alcohólica?
Abstract
Question
Steroidal therapy benefits patients with severe alcoholic hepatitis. However, steroid use is associated with severe side effects like infections and possibly, upper gastrointestinal bleeding. Pentoxifyllin, an inhibitor of Tumor Necrosis Factor has fewer side effects, but its effectiveness is not clear, nor its potential benefits as an adjunctive therapy to steroids.
Methods
We used Epistemonikos database, which is mantained through searches in 19 databases, to find systematic reviews and their included primary studies. A structured summary was created using a predefined format that includes key messages, a summary of the body of evidence (presented as a matrix of evidence in Epistemonikos), and a summary of findings table using the GRADE approach, along with other factors that aid decision-making.
Key messages
-Pentoxifyllin probably reduces mortality when compared with placebo.
-Pentoxifyllin could be less effective than steroid therapy for reducing mortality.
-Addition of pentoxifyllin to steroid therapy does not reduce mortality.
-Most practice guidelines have not taken into account an important portion of the existing evidence, even though their recommendations are in accordance with the present review.
QUESTION Steroidal therapy benefits patients with severe alcoholic hepatitis. However, steroid use is associated with severe side effects like infections and possibly, upper gastrointestinal bleeding. Pentoxifyllin, an inhibitor of Tumor Necrosis Factor has fewer side effects, but its effectiveness is not clear, nor its potential benefits as an adjunctive therapy to steroids.
METHODS We used Epistemonikos database, which is mantained through searches in 19 databases, to find systematic reviews and their included primary studies. A structured summary was created using a predefined format that includes key messages, a summary of the body of evidence (presented as a matrix of evidence in Epistemonikos), and a summary of findings table using the GRADE approach, along with other factors that aid decision-making.
KEY MESSAGES Pentoxifyllin probably reduces mortality when compared with placebo. Pentoxifyllin could be less effective than steroid therapy for reducing mortality. Addition of pentoxifyllin to steroid therapy does not reduce mortality. Most practice guidelines have not taken into account an important portion of the existing evidence, even though their recommendations are in accordance with the present review.
