Corticosteroids in severe alcohol-associated hepatitis. Not so fast: A systematic review of randomized controlled trials.

While corticosteroids are recommended for eligible patients with severe AH, no guidance exists for the timing of steroid initiation, tapering regimens, and surveillance of adverse events.

虽然对于符合条件的严重AH患者推荐使用皮质类固醇，但关于类固醇开始使用的时间、减量方案以及不良事件监测的指导方针尚不存在。

We aim to systematically review these variables and provide evidence-based recommendations for the inpatient and outpatient management of severe AH.

我们旨在系统地回顾这些变量，并为重症酒精性肝炎的住院和门诊管理提供基于证据的建议。

approach_and_results

We performed a literature search from inception to May 30, 2024, to include clinical trials published in full form and assessed the quality of evidence using the Cochrane Risk of Bias tool.

我们进行了从开始到2024年5月30日的文献搜索，包括以完整形式发表的临床试验，并使用Cochrane偏倚风险工具评估了证据的质量。

Data were collected on the timing of initiation, rate, and complications following steroid therapy, and taper regimens in the setting of severe AH.

收集了在严重自身免疫性肝炎背景下，糖皮质激素治疗的启动时间、速率以及并发症和减量方案的数据。

Of 28 studies that fulfilled our inclusion criteria, the median time from admission to steroid initiation was 6.5 days.

在满足我们纳入标准的28项研究中，从入院到开始使用糖皮质激素的中位时间是6.5天。

The most common steroid dosing regimen was prednisolone 40 mg daily for 28 days.

最常见的类固醇剂量方案是每日40毫克泼尼松，持续28天。

Twenty-five studies containing 3196 subjects reported adverse events, with exactly 50% in the steroid arm and the other half in the comparison arm.

25项研究包含3196名受试者报告了不良事件，其中正好50%在类固醇组，另一半在对照组。

Infections, gastrointestinal bleeds, and renal impairment were the most frequently reported adverse events.

感染、胃肠道出血和肾功能损害是最常报告的不良事件。

Most infections occurred within the first month of the study.

大多数感染发生在研究的第一个月内。

A 2-week steroid taper was the most frequently reported regimen.

2周的类固醇逐渐减量是最常报告的方案。

Conclusions

We recommend taking up to a week to systematically and thoroughly evaluate patients before initiating steroids, and vigilant monitoring in the first month of treatment.

我们建议在开始使用类固醇前，最多用一周时间对患者进行系统和彻底的评估，并在治疗的第一个月内进行严密监测。

We also recommend the lowest possible steroid exposure with a 2-week steroid taper and close outpatient follow-up.

我们还建议尽可能减少类固醇的暴露，采用2周的类固醇逐渐减量，并进行密切的门诊随访。