Treatment of severe alcoholic hepatitis by infusion of insulin and glucagon. A multicentre sequential trial

Trienchet, JC; Balkau, Beverley; Heintzmann, François; Poupon, R; Callard, P; Gotheil, C; Jd, Grangé; Vetter, Diana; Pauwels, Ans; Labadie, H; Chazouillères, O.; Mavier, Philippe; Desmorat, Hervé; Zarsky, JP; Jc, Barbare; Jf, Chambre; Ea, Pariente; Roulot, Dominique; Beaugrand, Michel

doi:10.1016/0168-8278(90)91585-k

Cited by 3 publications

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“…One of these studies showed a significant improvement in the short-term mortality rate after 4 wk (8-10). However, in the fourth and most recent study (published only in abstract form) the results were similar to ours in that the 4-wk mortality rate and liver biochemistry showed no improvement after 3 wk of treatment (11). The protocol for the administration of insulin and glucagon was broadly similar to that of previous studies, although there have been minor differences between trials in the total amount of insulin and glucagon given, the period of treatment and the rate of administration.…”

Section: Discussionsupporting

confidence: 86%

“…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%

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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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Section: Discussionsupporting

confidence: 86%

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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“…However, the clinical-laboratory diagnosis of AH is unreliable. Various studies have shown this diagnosis to be correct in only 10 to 15% of patients (77,78). Difficulties in recognizing AH are particularly high in cirrhotic patients.…”

Section: Liver Biopsy In Alcoholic Liver Disease (Ald)mentioning

confidence: 99%

Current indications of liver biopsy

Herruzo

2006

Rev. esp. enferm. dig.

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Pharmacological interventions for alcoholic liver disease (alcohol-related liver disease)

Buzzetti

Kalafateli

Thorburn

et al. 2017

Cochrane Database of Systematic Reviews

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Because of very low-quality evidence, there is uncertainty in the effectiveness of any pharmacological intervention versus no intervention in people with alcoholic hepatitis or severe alcoholic hepatitis. Based on low-quality evidence, propylthiouracil may decrease mortality in people with other alcohol-related liver diseases. However, these results must be confirmed by adequately powered trials with low risk of bias before propylthiouracil can be considered effective.Future randomised clinical trials should be conducted with approximately 200 participants in each group and follow-up of one to two years in order to compare the benefits and harms of different treatments in people with alcoholic hepatitis. Randomised clinical trials should include health-related quality of life and report serious adverse events separately from adverse events. Future randomised clinical trials should have a low risk of bias and low risk of random errors.

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Treatment of severe alcoholic hepatitis by infusion of insulin and glucagon. A multicentre sequential trial

Cited by 3 publications

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

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

Current indications of liver biopsy

Pharmacological interventions for alcoholic liver disease (alcohol-related liver disease)

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