In a new international study, investigators found that pentoxifylline, an anti-inflammatory drug often used to treat severe alcohol-associated hepatitis, may not improve survival in patients who also develop acute kidney injury.
The investigators analyzed data from 525 hospitalized patients across 20 medical centers in eight countries. All patients had severe alcohol-associated hepatitis (sAH) and met acute kidney injury (AKI) criteria at the time of admission. The investigators assessed whether pentoxifylline affected survival at 30, 90, or 180 days.
The results showed no statistically significant difference in survival between patients who received pentoxifylline and those who didn't. After adjusting for multiple factors, pentoxifylline wasn't associated with improved outcomes. The hazard ratio (HR) for mortality was 1.20 (95% confidence interval = 0.85–1.69, P = .291).
The cohort had a median age of 48 years, 26% were women, and 77% had a history of cirrhosis. The median Model for End-Stage Liver Disease (MELD) score was 35. Corticosteroids were used in 38.9% of cases, and nearly 60% experienced infections during hospitalization.
In a subgroup with more severe AKI (creatinine > 1.5 mg/dL), survival remained similar regardless of pentoxifylline use.
At 90 days, survival was 46.2% in the pentoxifylline group and 49.8% in the control group. Major causes of mortality included multiple organ failure (42%), infections (10%), bleeding from esophageal varices (7%), and renal failure (6%).
Independent predictors of mortality included older age, higher MELD scores, and the need for renal replacement therapy. In multivariable models, age (HR = 1.23 per 10 years), MELD score (HR = 1.06 per point), and dialysis (HR = 1.39) were all significantly associated with mortality.
Pentoxifylline is used more frequently in Latin America and Africa. Though it has shown anti-inflammatory effects in animal studies and limited benefits in conditions like diabetic kidney disease, this large, real-world study found no evidence that it improves survival in sAH with AKI.
The investigators stressed the need for more effective therapies for sAH, particularly in patients with kidney complications. Current standard care includes supportive treatment, corticosteroids in selected cases, and early management of complications such as infection and organ failure.
Based on these findings, pentoxifylline shouldn't be routinely used in patients with sAH and AKI unless supported by future clinical trials.
The authors reported no conflicts of interest.
Source: eGastroenterology
