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. 2019 Apr 9;2019(4):CD001511. doi: 10.1002/14651858.CD001511.pub4

Helman 1971.

Methods Randomised controlled trial
Country: USA
Intention‐to‐treat analysis: yes
Sample size calculation: not reported
Participants Demographic characteristics
Age (mean): 47.8 years (range 30–67 years)
Sex: 12 men and 25 women
Inclusion criteria and degree of severity
Diagnosis of alcoholic hepatitis confirmed by percutaneous needle biopsy. 70% of participants had anaemia on admission attributed to folate deficiency, blood loss, alcoholism, and haemolysis
Exclusion criteria
Biopsy could not be obtained within the first week of hospitalisation, gastrointestinal bleeding requiring transfusion, or if PPD was positive.
Authors reported that participants were classified into three groups, according to clinical severity of their disease. Quote: "Group I were severely ill – manifesting precoma or coma, group 2 were moderately ill, but no evidence of encephalopathy, group 3 were asymptomatic ambulatory patients."
Randomisation procedure
Random, double‐blind technique. Determined by hospital pharmacist, without informing physicians, nurses, or patients until completion of the study
Number of participants randomised: 37, divided in 3 groups according to severity of disease
Prednisolone group: n = 20
Control group: n = 17
Interventions Experimental group: prednisolone 40 mg daily
Control group: daily lactose placebo
Additional intervention: bed rest, high‐protein (100 g) and high‐calorie diet (3000 kcal) when tolerated and vitamin supplementation including folic acid. Sodium restriction instituted and all participants with ascites and oedema were treated with diuretics.
Duration of treatment: 6 weeks: 4 weeks and 2‐week period tapered
Duration of follow‐up after randomisation: 4 months
Outcomes Mortality
Liver biochemistry
Liver histology
Adverse events
Notes Quote: "tablets 40 mg of prednisolone daily or lactose placebo (provided by Upjohn Co, Kalamazoo, Mich)."
Letter sent to authors in March 2000. No answer received
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not described.
Quote: "patients were selected by a random, double‐blind technique …"
Allocation concealment (selection bias) Low risk Quote: "Drug treatment was randomly determined by the hospital pharmacist, without informing physicians, nurses, or patients until completion of the study."
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Quote: "… The treatment code was broken during the study in only one case because of a medical emergency."
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk Not described
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No withdrawals or dropouts
Selective reporting (reporting bias) High risk No protocol available. However, all‐cause mortality and liver‐related mortality were reported.
Other bias Low risk