Therapy for alcoholic liver disease

Table 2 Meta-analyses of randomized controlled trials of corticosteroid therapy vs placebo for severe alcoholic hepatitis

Ref.	Inclusion criteria	Number of RCTs (total number of patients)	Endpoint parameters (primary endpoint listed on first line of each entry)	RR, HR or OR for primary endpoint	95%CI	Comments
Imperiale et al[102], 1990	RCTs of patients with acute AH receiving corticosteroids vs placebo	11 (562)	Mortality Hepatic encephalopathy	RR = 0.63	0.5-0.8	Positive study (P = 0.025)
Christensen et al[101], 1995	RCTs evaluating short term effect on survival of treatment with glucocorticoids vs placebo for AH	13 (659)	Mortality Age Serum bilirubin Ascites Male gender Hepatic encephalopathy	RR = 0.78	0.51-1.18	Negative study (P = 0.2)
Mathurin et al[55], 2002	RCTs during 1984-1992 of patients receiving glucocorticoids vs placebo	3 (215)	Survival Age Liver function tests DF Hepatic encephalopathy Gender Serum creatinine Ascites Leukocyte count	OR = 0.39	0.22-0.71	Positive study (P = 0.002) Used individual patient data analysis to increase statistical rigor for the meta-analysis
Rambaldi et al[100], 2008	RCTs of patients with severe, clinically overt AH diagnosed by clinical and biochemical criteria, treated with glucocorticoids vs placebo (or no intervention)	15 (721)	Mortality Liver-related mortality Symptoms and complications Liver function tests Liver histology Adverse events	RR = 0.83	0.63-1.11	Negative study (P = 0.21)
Mathurin et al[99], 2011	RCTs from 1984 to 2006 with specific data on DF ≥ 32 or hepatic encephalopathy, of corticosteroids vs placebo, enteral nutrition or antioxidants	5 (418)	Survival DF Lille score Liver function tests	Complete responder: HR = 0.18	Complete responder: 0.05-0.71	Positive study Complete responders (P = 0.005)
			Serum creatinine Ascites	Partial responder: HR = 0.38	Partial responder: 0.17-0.87	Partial responders (P = 0.03)
			Hepatic encephalopathy Age	Null responder: HR = 0.81	Null responder: 0.45-1.45	Null responders (P = 0.46)
			Gender Leukocyte count			Used individual patient data analysis to increase statistical rigor for the meta-analysis

RCT: Randomized controlled trials; AH: Alcoholic hepatitis; DF: Discriminant function.