Table 1.
Intervention Class | Examples, Indications and Limitations |
---|---|
Nutritional support | Address protein calorie malnutrition (High calorie meals and supplements), and vitamin deficiency (Vitamin A, Vitamin D, Thiamine, Folate) through supplementation. |
Alcohol Abstinence | Most important component of therapy, often a multidisciplinary team recommended for successful management. |
Corticosteroids | Prednisolone: first line therapy for severe AH (indicated with DF > 32 or HE) AASLD/EASL recommendations: 40mg/day for 4 weeks Assess response after a week: Lille score> 0.45, discontinue therapy Rule out infection and GI bleeding before initiating therapy |
Phosphodiesterase inhibitor: | Pentoxifylline: inhibits TNF Second line agent. Not an effective rescue therapy agent. |
Anti-TNF agents | Infliximab/Etanercept Large studies showed increased adverse effects: Infections, mortality Currently not recommended for AH |
N-acetylcysteine | Replenishes Glutathione in damaged hepatocytes and prevents cell death. Used in Acute Hepatitis from other causes. Studies on Prednisolone and NAC combination therapy have shown reduction in 1-month mortality rate, HRS incidence, and Infection incidence, but no effect on improving 6-month mortality. |
DF: Maddrey’s discriminant function, HE: Hepatic encephalopathy, TNF: Tumor necrosis factor, HRS: Hepatorenal Syndrome