Network Meta‐Analysis: Treatments for Acute Alcohol‐Associated Hepatitis

Background Alcohol‐related hepatitis (AH) is an acute form of liver disease with a high short‐term mortality. A variety of treatments have been explored in randomised studies. Recent consensus on study outcomes has identified 90‐day survival as the primary outcome metric. Aims This systematic review and network meta‐analysis is to update understanding of the comparative efficacy of treatments for AH, based on 90‐day survival, to inform future Phase III studies. Methods PubMed, Ovid‐Medline and Embase were searched for randomised studies of treatments of AH. The risk of bias in included papers was measured using the Cochrane risk of bias 2 tool. Data were synthesised with network meta‐analysis to estimate risk ratio (RR) of survival at 90 days after randomisation. Heterogeneity was assessed with the magnitude of the between‐study variance (tau 2 ). Results Thirty five studies including 5045 participants were identified that examined 24 treatments for AH. Twenty‐three studies were considered to be at low risk of bias. In network meta‐analysis considering placebo as the reference treatment, only granulocyte colony stimulating factor (GCSF) showed a statistically significant benefit on 90‐day mortality (RR 0.49, 95% CI 0.28–0.84; p = 0.009). In subgroup analysis of studies at low risk of bias, no treatments showed a significant effect on mortality at 90 days. Conclusions Individual studies are small and heterogeneity is marked; however, some agents show promise to improve survival at 90 days in people with AH. This information should inform adequately powered studies to explore potential treatments for AH.