Comparative Evaluation of Pentoxifylline Combined with Glutathione Versus Prednisolone in the Management of Alcoholic Hepatitis: A Prospective Longitudinal Study

Abstract

Background: Chronic alcohol use leads to Alcoholic Liver Disease (ALD) which mainly include Liver Cirrhosis, a condition that causes scarring in the liver tissues ultimately results in decompensated conditions. Pentoxifylline (PTX), a nonspecific phosphodiesterase inhibitor, also decreases the production of TNF-α, IL-5, IL-6, IL-10 and IL-12. Most commonly given dose is 400mg for adults. Steroid mainly Prednisolone represent most widely accepted therapy for severe ALD. It act by reducing cytokine production, IL-1, IL-6, IL-8. Administration of oral dose of Prednisolone with dose 40-60mg/day for a total duration of 4 weeks. Glutathione plays a critical role in the maintenance of cell function and viability. Methods: A Prospective longitudinal study contains total of 43 patients, 23 patients in group A (Pentoxifylline + Glutathione) and 20 patients in group B (Pentoxifylline + Prednisolone) was evaluated for a period of 6 months consist of data collection and follow-up using structured performa. Results: A total of 42 patients were analyzed during the study. Alcoholic Hepatitis was found to be mostly affect the age group of 41 to 50 years and the mean age group was found to be 47.7 + 10.5 for group A and 48.1 + 8.3 for group B. Efficacy of given drugs was assessed by laboratory parameters and study tools. The p value for most of the parameters such as Liver Function Test, Hemoglobin, INR showed high significance in group A than group B. Study tools such as Maddrey Discriminant Function score, Model for End Stage Liver Disease score, Child Pugh score, Chronic Liver Disease Questionnaire showed equal high significance in both groups. Safety was determined by development of adverse events, group A had less incidence of adverse events when compared to group B. Conclusion: Pentoxifylline plus Glutathione combination has a better treatment outcome when compared to Pentoxifylline plus Prednisolone combination. Both the study drugs are equally effective in improving the Liver parameters but, more efficacy and safety were shown by group A drugs (Pentoxifylline + Glutathione). It also improved the quality of life who suffered from severe complication of Alcoholic Hepatitis such as Ascites, Jaundice, Hepatic Encephalopathy etc.