Beyond corticosteroids: A systematic review of novel therapeutic strategies in severe alcoholic hepatitis and 90-day survival

Table 1 GRADE summary of findings: Severe alcoholic hepatitis treatments

Intervention	Comparator	Outcome	No. of Studies	Study design	Certainty (GRADE)	Effect estimate	Comments
Corticosteroids[13,14]	Placebo[13]	90-day mortality	1	RCT	↑↑↑↑ (high)	OR 1.02 (P = 0.87)	No benefit observed
	Non-treatment[14]		1	Observational study	↑↑↑ (moderate)	HR 0.92 (P = 0.871)	Downgraded one level due to study design
Pentoxifylline[13]	Placebo	90-day mortality	1	RCT	↑↑↑↑ (high)	OR 0.97 (P = 0.81)	No benefit observed
Anakinra + zinc[15]	Prednisone	90-day survival	1	RCT	↑↑↑ (moderate)	HR 0.34 (P = 0.018)	The findings across studies are inconsistent
Anakinra + zinc + pentoxifylline[16]	Methylprednisolone	90-day survival	1	RCT	↑↑ (low)	HR 0.69 (P = 0.28)	HR reported without CI; precision cannot be assessed. Downgraded one level due to serious imprecision
G-CSF[17]	Corticosteroids	90-day survival	1	Observational study	↑↑↑ (moderate)	HR 0.38 (P < 0.01)	Strength: Large cohort with global scope; Weakness: Needs RCT validation
	Standard medical treatment				↑↑↑ (moderate)	HR 0.26 (P < 0.01)
Amoxicillin-clavulanate + prednisolone[18]	Prednisolone	90-day mortality	1	RCT	↑↑↑↑ (high)	HR 0.78 (P = 0.30)	No significant effect
FMT[19]	Prednisolone	90-day survival	1	Randomized control trial	↑↑↑↑ (high)	HR 0.528 (P = 0.044)	Promising results; small sample
ELAD[20]	Standard of care	91-day survival	1	RCT	↑↑↑↑ (high)	HR 1.03 (P = 0.90)	No benefit observed

OR: Odds ratio; HR: Hazard ratio; CI: Confidence interval; G-CSF: Granulocyte colony-stimulating factor; RCT: Randomized control trial; FMT: Fecal microbiota transplantation; ELAD: Extracorporeal liver assist device.