Andrea Rambaldi

Systematic review: glucocorticosteroids for alcoholic hepatitis – a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials

Background  Glucocorticosteroids versus placebo or no intervention for patients with alcoholic hepatitis have been evaluated for more than 35 years. However, the results of randomized trials and meta‐analyses differ substantially.

Milk Thistle for Alcoholic and/or Hepatitis B or C Liver Diseases—A Systematic Cochrane Hepato-Biliary Group Review with Meta-Analyses of Randomized Clinical Trials

OBJECTIVES:Our objectives were to assess the beneficial and harmful effects of milk thistle (MT) or MT constituents versus placebo or no intervention in patients with alcoholic liver disease and/or hepatitis B and/or C liver diseases.METHODS:Randomized clinical trials studying patients with alcoholic and/or hepatitis B or C liver diseases were included (December 2003). The randomized clinical trials were evaluated by components of methodological quality.RESULTS:Thirteen randomized clinical trials assessed MT in 915 patients with alcoholic and/or hepatitis B or C liver diseases. The methodological quality was low: only 23% of the trials reported adequate allocation concealment and only 46% were considered double blind. MT versus placebo or no intervention for a median duration of 6 months had no significant effects on all-cause mortality (relative risk (RR) 0.78, 95% confidence interval (CI) 0.53–1.15), complications of liver disease, or liver histology. Liver-related mortality was significantly reduced by MT in all trials (RR 0.50, 95% CI 0.29–0.88), but not in high-quality trials (RR 0.57, 95% CI 0.28–1.19). MT was not associated with a significantly increased risk of adverse events.CONCLUSIONS:Based on high-quality trials, MT does not seem to significantly influence the course of patients with alcoholic and/or hepatitis B or C liver diseases. MT could potentially affect liver injury. Adequately conducted randomized clinical trials on MT versus placebo may be needed.

Anabolic-androgenic steroids for alcoholic liver disease: a Cochrane Review

OBJECTIVES:The objectives were to assess the beneficial and harmful effects of anabolic-androgenic steroids for alcoholic liver disease.METHODS:The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Library, MEDLINE, EMBASE, and full text searches were combined. Only randomized clinical trials studying patients with alcoholic liver disease were included. Interventions encompassed anabolic-androgenic steroids at any dose or duration versus placebos or no intervention. The statistical package (RevMan and MetaView) provided by The Cochrane Collaboration was used.RESULTS:Five randomized clinical trials (including mainly men with alcoholic hepatitis and/or cirrhosis) were identified. Only one trial was assessed as adequate regarding all methodological quality components. Anabolic-androgenic steroids versus placebos or no intervention demonstrated no significant effects on mortality (relative risk [RR]= 0.96, 95% CI = 0.72–1.28), liver-related mortality (RR = 0.83, 95% CI = 0.60–1.15), complications to the liver disease (RR = 1.25, 95% CI = 0.74–2.10), liver histology, and a number of other outcome measures. Anabolic-androgenic steroids were not associated with a significantly increased risk of nonserious adverse events, but with the seldom occurrence of serious adverse events (RR = 4.54, 95% CI = 0.57–36.30).CONCLUSIONS:This systematic review could not demonstrate any significant beneficial effects of anabolic-androgenic steroids on any clinically important outcomes of patients with alcoholic liver disease.