Background/Aims:Severe alcoholic hepatitis is associated with high morbidity and short-term mortality.Corticosteroids are the only widely used therapy but established contraindications to treatment or the risk of serious side-effects limit their use.The perceived need for alternative treatments together with the theoretical benefits of anti-oxidant therapy triggered the design of a randomised clinical trial comparing these treatment modalities.Methods:One hundred and one patients were randomized into a clinical trial of corticosteroids or a novel antioxidant cocktail with a primary endpoint of 30-day mortality.Results:At 30 days there were 16 deaths(30%)in the corticosteroid treated group compared with 22 deaths(46%)in the antioxidant treated group(P=0.05).The odds of dying by 30 days were 2.4 greater for patients on antioxidants(95%confidence interval 1.0-5.6).A diagnosis of sepsis was made more frequently in the AO group(P=0.05),although microbiologically proven episodes of infection occurred more often in the CS group(P < 0.01).The survival advantage for corticosteroid treated patients was lost at 1 year of follow-up(P=0.43).Conclusions:This study has shown that corticosteroids in the form of prednisolone 30 mg daily are superior to a broad antioxidant cocktail in the treatment of severe alcoholic hepatitis.
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