Network Meta-Analysis: Treatments for Acute Alcohol-Associated Hepatitis.
Charles Gallaher, Guruprasad P Aithal, Ashwin Dhanda et al.
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In 30 seconds
This systematic review and network meta-analysis compared treatments for alcohol-associated hepatitis (AH) using 90-day survival as the primary outcome. It included 35 randomised studies with 5045 participants evaluating 24 treatments; 23 studies were judged at low risk of bias. Against placebo, granulocyte colony stimulating factor (GCSF) was the only treatment with a statistically significant survival benefit in the overall analysis (mortality RR 0.49, 95% CI 0.28-0.84; p = 0.009). However, no treatment showed a significant mortality effect in the subgroup of low-risk-of-bias studies.
Key findings
- Across 35 studies and 5045 participants, 24 treatments for AH were assessed using network meta-analysis.
- Compared with placebo, GCSF was associated with lower 90-day mortality (RR 0.49, 95% CI 0.28-0.84; p = 0.009).
- In analyses restricted to studies at low risk of bias, no treatment significantly affected 90-day mortality.
Why it matters
Ninety-day survival is a clinically important outcome in a condition with high short-term mortality. The analysis offers a comparative overview of treatments studied to date, while showing that apparent benefit for GCSF is not robust to restriction by risk of bias. These findings help identify uncertainty and inform the design of adequately powered trials.
What to keep in mind
The authors report that individual studies are small and heterogeneity is marked; the apparent GCSF benefit was not significant in the low-risk-of-bias subgroup.