GCSF plus prednisolone improves survival in severe alcohol-associated hepatitis

The addition of granulocyte colony-stimulating factor (GCSF) to prednisolone results in improved steroid responsiveness and prolonged survival with fewer infections and new-onset complications among patients with severe alcohol-associated hepatitis (SAH), a study has shown.

Researchers randomly allocated steroid-eligible patients with SAH (discriminant function scores 32‒90) to receive prednisolone alone (n=42), GCSF alone (n=42), or GCSF plus prednisolone (GPred; n=42). GCSF was administered at 150‒300 mcg/day for 7 days, followed by every third day for a maximum of 12 doses in 1 month. Prednisolone 40 mg/day was given for 7 days and continued for 28 days in responders.

Baseline characteristics did not significantly differ across treatment groups. Intention-to-treat analysis revealed higher 90-day survival rates in the GPred group compared with prednisolone- and GCSF-only groups (88.1 percent vs 64.3 percent and 78.6 percent, respectively; p=0.03 for prednisolone vs GPred).

No significant between-group difference was noted for 28-day survival (95.2 percent vs 85.7 percent and 85.7 percent, respectively; p=0.27).

The GPred group also had more responders by day 7 (92.9 percent vs 71.4 percent and 76.2 percent; p=0.037) and showed greater reduction in discriminant function (‒24.59 vs ‒7.33 and ‒14.59; p=0.011) and MELDNa (‒7.02 vs ‒1.69 and ‒3.05; p=0.002) by day 90.

The incidence of new infections was higher in the prednisolone-only group (35.7 percent vs 19 percent and 7.1 percent; p<0.002) than the GPred and GCSF-only groups.

In addition, the GPred group showed lower rates of acute kidney injury (7.1 percent vs 33.3 percent and 11.9 percent; p=0.002), hepatic encephalopathy (9.5 percent vs 35.7 percent and 26.2 percent; p<0.001), and rehospitalizations (14.3 percent vs 59.5 percent and 30.9 percent; p<0.01) than the prednisolone- and GCSF-only groups.