Granulocyte colony-stimulating factor plus pentoxifylline increases short-term survival in patients with severe alcoholic hepatitis: a network meta-analysis

ABSTRACT

Background: Optimal treatments for severe alcoholic hepatitis (SAH) remain controversial. Previous network meta-analysis showed that corticosteroid (CS) combined with N-acetylcysteine (NAC) was superior in reducing short-term mortality of patients with SAH. Recently, granulocyte colony-stimulating factor (G-CSF) treatments for SAH yielded promising results.

Objectives: To determine how currently available treatments affect the survival and complications of patients with SAH.

Methods: The study was conducted following the guidelines of PRISMA. The data from PubMed, Embase, MEDLINE, Cochrane Library, and clinicaltrials.gov to October 2022 were searched, and patients with SAH with pharmacotherapy were included in our study. The primary outcome was short-term survival, and the other outcomes were medium- (3/6 months) or long-term (12 months) survival and complications after treatment. R software was used to establish network meta-analysis models and the result was expressed by the odd ratio (OR) value and 95% credible interval (Crls).

Results: A total of 31 randomized controlled trials, including 19 treatment regimens, were enrolled in our study. As the primary outcome, G-CSF+ pentoxifylline (PTX) ranked first in one-month survival and showed significant superiority when compared with the placebo (OR 8.60, 95% Crls 1.92–45.10) and CS (OR 4.95, 95% Crls 1.11–25.53). Also, G-CSF+PTX ranked first in improving three-month survival and reducing the occurrence of infection. PTX+MTD ranked first in six-month survival, and G-CSF ranked first in twelve-month survival. CS+MTD ranked first in the occurrence of gastrointestinal bleeding and hepatorenal syndrome.

Conclusions: The combination of G-CSF and PTX showed a significant benefit in improving the short-term survival of SAH patients.

KEYWORDS:

• Severe alcoholic hepatitis
• short-term mortality
• granulocyte colony-stimulating factor
• randomized control trial
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All the authors contributed to the writing of the manuscript. S.Y. and J.C. designed this research. F.D. and C.L screened and extracted the data. D.F, C.C., H.Z. and S.S. analyzed and interpreted the data. F.D. and S.Y. wrote the manuscript and S.Y. contributed to the scientific discussion. All authors approved the final version of the manuscript.

Data availability statement

Datasets are available on request.

List of abbreviations

SAH	=	severe alcoholic hepatitis
CS	=	corticosteroid
NAC	=	N-acetylcysteine
PTX	=	pentoxifylline
G-CSF	=	granulocyte colony-stimulating factor
MTD	=	metadoxine
RCT	=	randomized controlled trails
OR	=	odds ratio
Crls	=	credible interval
SUCRA	=	surface under the cumulative ranking curve

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00952990.2023.2266117.

Additional information

Funding

This study was supported by the High-level public health talent cultivation project [XKGG-02-30], Beijing Municipal Administration of Hospitals Incubating Program [PX2022071] and the Tianqing Foundation of Chinese Foundation for hepatitis prevention and control [TQGB20210050].