Skip to main content
SpringerLink
Log in

Prednisolone plus S-adenosil-l-methionine in severe alcoholic hepatitis

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Purpose/background

Severe alcoholic hepatitis (AH) is a life-threatening liver disease with a potential of 30–40 % mortality at 1 month. While steroids remain to be a first line therapy, they provide only about 50 % survival benefit. The aim of the study was to evaluate the efficacy of glucocorticoids plus S-adenosylmethionine (SAMe), as compared to glucocorticoids alone, in patients with severe alcoholic hepatitis.

Methods

Forty patients with severe AH were randomized in two groups and enrolled in the prospective trial. Group 1 (n = 20) patients received prednisolone 40 mg/daily per os, and group 2 (n = 20) patients were managed with prednisolone 40 mg/daily per os plus SAMe 800 mg i.v. treatment. Duration was 28 days.

Results

The response rate assessed by Lille model was significantly higher in the prednisolone plus SAMe group (19 of 20; 95 %) than in the prednisolone group (13 of 20; 65 %), p = 0.044. Two (10 %) patients died, both from the prednisolone group. There were no lethal outcomes in the prednisolone plus SAMe group. The Kaplan–Meier method showed no significant differences between the two groups (p = 0.151, log-rank). Hepatorenal syndrome (HRS) occurred in 20 % in the prednisolone group (4 of 20 patients) while no HRS cases were registered in the prednisolone plus SAMe group (p = 0.035).

Conclusions

Management of severe alcoholic hepatitis with prednisolone plus SAMe was associated with better therapy response (p = 0.044) and less frequent HRS occurrence (p = 0.035). Mortality was not significantly lower in the prednisolone–SAMe group than in the prednisolone-only group at 28 days (10 vs. 0 %, p = 0.151).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mayevskaya MV, Morozova MA, Ivashkin VT. Algorithm of management of patient with alcohol-induced liver disease. Russ J Gastroenterol Hepatol Coloproctol 2011;17(6):4–10

  2. Bueverov AO, Mayevskaya MV, Ivashkin VT. Differentiated management of alcoholic liver disease. Russ J Gastroenterol Hepatol Coloproctol 2005;15(5):4–10

  3. Ivashkin VT. Gastroenterology. Geotar-Media; 2015

  4. Mayevskaya MV. Alcohol, alcoholism and related consequences. Russ J Gastroenterol Hepatol Coloproctol 2013;23(6):43–48

  5. Anstee Q, Day C. S-adenosylmethionine (SAMe) therapy in liver disease: a review of current evidence and clinical utility. J Hepatol 2012;57:1097–1109

  6. Bush KR, Bradley KA, McDonell MB, Malone T, Fihn SD; the Ambulatory Care Quality Improvement Project. Screening for problem drinking: comparison of CAGE and AUDIT. J Gen Intern Med 1998;13(6):379–388

  7. Louvet A, Naveau S, Abdelnour M, Ramond MJ, Diaz E, Fartoux L et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007;45(6):1348–1354

  8. Luedde T, Kaplowitz N, Schwabe RF. Cell death and cell death responses in liver disease: mechanisms and clinical relevance. Gastroenterology 2014;147:765–783

  9. Brenner C, Galluzzi L, Kepp O, Kroemer G. Decoding cell death signals in liver inflammation. J Hepatol 2013;59:583–594

  10. Copple BL, Jaeschke H, Klaassen CD. Oxidative stress and the pathogenesis of cholestasis. Semin Liver Dis 2010;30(2):195–204

  11. Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol 2012;4:81–90

  12. Song Z, Zhou Z, Chen T, Hill D, Kang J, Barve S et al. S-adenosylmethionine (SAMe) protects against acute alcohol induced hepatotoxicity in mice. J Nutr Biochem 2003;14(10):591–597

  13. Colell A, Garcia-Ruiz C, Miranda M, Ardite E, Mari M, Morales A et al. Selective glutathione depletion of mitochondria by ethanol sensitizes hepatocytes to tumor necrosis factor. Gastroenterology 1998;115(6):1541–1551

  14. Pavlov CS, Casazza G, Nikolova D et al. S-adenosyl-l-methionine for people with alcoholic liver disease (protocol). Cochrane Database Syst Rev 2015;1:CD010542. (Art. No.: CD011949)

  15. Mato JM, Camara J, Fernandez de Paz J, Caballeria L, Coll S, Caballero A et al. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebocontrolled, double-blind, multicenter clinical trial. J Hepatol 1999;30(6):1081–1089

  16. Nguyen-Khac E, Thevenot T, Piquet M. Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. N Engl J Med 2011;365:1781–1789

  17. Louvet A, Mathurin P. Alcoholic liver disease: mechanisms of injury and targeted treatment. Nat Rev Gastroenterol Hepatol 2015;12:231–242

  18. Watson W, Burke T, Doll M, McClain C. S-adenosylhomocysteine inhibits NFκB-mediated gene expression in hepatocytes and confers sensitivity to TNF cytotoxicity. Alcohol Clin Exp Res 2014;38(4):889–896

Download references

Author information

Authors and Affiliations

  1. I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

    Petr Tkachenko, Marina Maevskaya, Alexander Pavlov, Inna Komkova, Chavdar Pavlov & Vladimir Ivashkin

Authors
  1. Petr Tkachenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marina Maevskaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Pavlov
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inna Komkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chavdar Pavlov
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vladimir Ivashkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Petr Tkachenko.

Ethics declarations

Conflict of interests

Petr Evgeniy Tkachenko, Marina Maevskaya, Alexander Pavlov, Inna Komkova, Chavdar Pavlov, and Vladimir Ivashkin declare that they have no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tkachenko, P., Maevskaya, M., Pavlov, A. et al. Prednisolone plus S-adenosil-l-methionine in severe alcoholic hepatitis. Hepatol Int 10, 983–987 (2016). https://doi.org/10.1007/s12072-016-9751-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-016-9751-4

Keywords

Search

Navigation