A randomized clinical trial of insulin and glucagon infusion for treatment of alcoholic hepatitis: Progress report in 50 patients

Baker, Alfred L.; Jaspan, Jonathan B.; Haines, Norman W.; Hatfield, Glenn E.; Krager, Patricia S.; Schneider, John F.

doi:10.1016/0016-5085(81)90250-x

Cited by 82 publications

(14 citation statements)

References 17 publications

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“…Although an array of potential treatments have been studied, including corticosteroids, nutritional supplementation, anabolic steroids, insulin/glucagon, colchicine, propylthiouracil, d-penicillamine, and pentoxifylline 4–14, the optimum treatment regimen is controversial and varies between medical centers.…”

Section: Introductionmentioning

confidence: 99%

A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Etanercept in the Treatment of Alcoholic Hepatitis

et al. 2008

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Background-Alcoholic hepatitis is a cause of major morbidity and mortality that lacks effective therapies. Both experimental and clinical evidence indicate that the multifunctional cytokine tumor necrosis factor-α (TNFα) contributes to pathogenesis and clinical sequelae of alcoholic hepatitis. A pilot study demonstrated that the TNFα-neutralizing molecule, etanercept, could be an effective treatment for patients with alcoholic hepatitis.

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Section: Introductionmentioning

confidence: 99%

A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Etanercept in the Treatment of Alcoholic Hepatitis

et al. 2008

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“…Frequencies of various treatments such as plasma exchange, charcoal hemoperfusion, Fischer's amino acid solution (23), glucagon-insulin therapy (24)(25)(26)(27) and histamine (H2) receptor antagonist were notsignificantly different between the survivor and nonsurvivor.…”

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confidence: 99%

A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation

Takahashi

Kumada

Shimizu³

et al. 1994

Hepatology

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To determine the risk of death at an early stage of fulminant viral hepatitis, we created severity indexes drawn from clinical data on the day of development of encephalopathy in 128 patients with fulminant hepatitis B and 103 with fulminant hepatitis non-A, non-B. In fulminant hepatitis B, the risk score was 2.75 x BL + 2.75 x BR + 2.7 x AG + 2.3 x WB + 1.67 x CD + 1.56 x AL - 0.098 x PR - 0.88, where BL is 1 if total bilirubin is higher than 20 mg/dl, BR is 1 if the ratio of total to direct bilirubin exceeds 2.2, AG is 1 if age is above 40 yr, WB is 1 if white blood cell count is less than 4,000 cells/mm3 or more than 18,000 cells/mm3, CD is 1 if a hazardous disease coexists and AL is 1 if ALT is less than 100 times the upper limit of normal (otherwise all are 0), and PR is prothrombin time (percentage of normal value). Using a cutoff score of 0, we found the positive predictive value, negative predictive value and predictive accuracy to be 0.90, 0.86 and 0.89, respectively. Sensitivity and specificity were 0.94 and 0.77, respectively. In fulminant non-A, non-B hepatitis, the risk score was 2.66 x BR + 2.25 x BL + 2.24 x DI + 2.05 x AL +/- 1.38 x AG + 0.00021 x WB - 6.33.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…In previous studies of insulin and glucagon therapy in acute alcoholic hepatitis, a benefit was suggested in short-term mortality and faster improvement in serum liver biochemistry in surviving patients over the 4 wk of the study (8)(9)(10). In this study, 15 of 43 patients treated with insulin and glucagon died within 4 wk, compared with 14 of 43 treated with placebo (not statistically significant).…”

Section: Discussionmentioning

confidence: 51%

“…The combination was also effective in promoting recovery in animal models of fulminant viral hepatitis and stimulating hepatocytes in primary cell culture (6,7). To date, four controlled trials have evaluated repeated insulin and glucagon infusion in acute alcoholic hepatitis (8)(9)(10)(11). Three of these have shown benefits with respect to decreased short-term mortality rates or improvement in serum liver biochemistry.…”

Section: -1101)mentioning

confidence: 99%

Insulin and glucagon infusion in acute alcoholic hepatitis: A prospective randomized controlled trial

et al. 1991

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In a randomized, controlled trial to investigate the possible benefit of insulin and glucagon therapy in severe acute alcoholic hepatitis, 86 patients were randomized to receive 30 U insulin and 3 mg glucagon in 250 ml 5% dextrose over 12 hr each day for 3 wk or a similar regime of identical placebo. No significant differences were seen in patients' clinical characteristics and disease severity in the treated and placebo groups. Of the 43 patients receiving insulin and glucagon, 15 (35%) died within 4 wk of randomization, compared with 14 deaths (33%) in the control patients (p = not significant). When the patients surviving the first 4 wk were examined there were five more deaths in the treatment group, compared with one death in the control group at 6-mo follow-up (p = not significant). No significant differences in the frequency of short-term or long-term complications of alcoholic liver disease or relapse to alcohol were seen when the two groups were compared, although hypoglycemia was seen in six patients during infusion of insulin and glucagon. Similarly, no significant differences were seen in the improvement in clinical or biochemical features at 4 wk and at 6 mo in survivors when the insulin and glucagon-treated patients were compared with patients in the placebo group. This study does not confirm previous reports that insulin and glucagon infusion improves the outcome of severe acute alcoholic hepatitis.

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A randomized clinical trial of insulin and glucagon infusion for treatment of alcoholic hepatitis: Progress report in 50 patients

Cited by 82 publications

References 17 publications

A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Etanercept in the Treatment of Alcoholic Hepatitis

A Randomized, Double-Blinded, Placebo-Controlled Multicenter Trial of Etanercept in the Treatment of Alcoholic Hepatitis

A multicenter study on the prognosis of fulminant viral hepatitis: Early prediction for liver transplantation

Insulin and glucagon infusion in acute alcoholic hepatitis: A prospective randomized controlled trial

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