***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS An earlier pilot study from our liver unit suggested benefit from treatment with pentoxifylline ( PTX ) , an inhibitor of tumor necrosis factor ( TNF ) , in severe acute alcoholic hepatitis . The aim of the present study was to evaluate this treatment in a larger cohort of patients . METHODS One hundred one patients with severe alcoholic hepatitis ( Maddrey discriminant factor > or = 32 ) entered a 4-week double-blind r and omized trial of PTX ( 400 mg orally 3 times daily ) vs. placebo . Primary endpoints of the study were the effect of PTX on ( 1 ) short-term survival and ( 2 ) progression to hepatorenal syndrome . On r and omization , there were no differences in demographic and clinical characteristics or laboratory values ( including TNF ) between the 2 groups . RESULTS Twelve ( 24.5 % ) of the 49 patients who received PTX and 24 ( 46.1 % ) of the 52 patients who received placebo  died during the index hospitalization ( P = 0.037 ; relative risk , 0.59 ; 95 % confidence interval , 0.35 - 0.97 ) . Hepatorenal syndrome was the cause of death in 6 ( 50 % ) and 22 ( 91.7 % ) patients ( P = 0.009 ; relative risk , 0.29 ; 95 % confidence interval , 0.13 - 0.65 ) . Three variables ( age , creatinine level on r and omization , and treatment with PTX ) were independently associated with survival . TNF values on r and omization were not predictive of survival ; however , during the study period they increased markedly in nonsurvivors compared with survivors in both groups . CONCLUSIONS Treatment with PTX improves short-term survival in patients with severe alcoholic hepatitis . The benefit appears to be related to a significant decrease in the risk of developing hepatorenal syndrome . Increasing TNF levels during the hospital course are associated with an increase in mortality rate IMPORTANCE Prednisolone or pentoxifylline is recommended for severe alcoholic hepatitis , a life-threatening disease . The benefit of their combination is unknown . OBJECTIVE To determine whether the addition of pentoxifylline to prednisolone is more effective than prednisolone alone . DESIGN , SETTING , AND PARTICIPANTS Multicenter , r and omized , double-blind clinical trial conducted between December 2007 and March 2010 in 1 Belgian and 23 French hospitals of 270 patients aged 18 to 70 years who were heavy drinkers with severe biopsy-proven alcoholic hepatitis , as indicated by recent onset of jaundice in the prior 3 months and a Maddrey score of at least 32 . Duration of follow-up was 6 months . The last included patient completed the study in October 2010 . None of the patients were lost to follow-up for the main outcome . INTERVENTION Patients were r and omly assigned to receive either a combination of 40 mg of prednisolone once a day and 400 mg of pentoxifylline 3 times a day ( n=133 ) for 28 days , or 40 mg of prednisolone and matching placebo ( n=137 ) for 28 days . MAIN OUTCOMES AND MEASURES Six-month survival , with secondary end points of development of hepatorenal syndrome and response to therapy based on the Lille model , which defines treatment nonresponders after 7 days of initiation of treatment . RESULTS In intention-to-treat analysis , 6-month survival was not different in the pentoxifylline-prednisolone and placebo-prednisolone groups ( 69.9 % [ 95 % CI , 62.1%-77.7 % ] vs 69.2 % [ 95 % CI ; 61.4%-76.9 % ] , P = .91 ) , corresponding to 40 vs 42 deaths , respectively . In multivariable analysis , only the Lille model and the Model for End-Stage Liver Disease score were independently associated with 6-month survival . At 7 days , response to therapy assessed by the Lille model was not significantly different between the 2 groups ( Lille model score , 0.41 [ 95 % CI , 0.36 - 0.46 ] vs 0.40 [ 95 % CI , 0.35 - 0.45 ] , P = .80 ) . The probability of being a responder was not different in both groups ( 62.6 % [ 95 % CI , 53.9%-71.3 % ] vs 61.9 % [ 95 % CI , 53.7%-70.3 % ] , P = .91 ) . The cumulative incidence of hepatorenal syndrome at 6 months was not significantly different in the pentoxifylline-prednisolone and the placebo-prednisolone groups ( 8.4 % [ 95 % CI , 4.8%-14.8 % ] vs 15.3 % [ 95 % CI , 10.3%-22.7 % ] , P = .07 ) . CONCLUSION AND RELEVANCE In patients with alcoholic hepatitis , 4-week treatment with pentoxifylline and prednisolone , compared with prednisolone alone , did not result in improved 6-month survival . The study may have been underpowered to detect a significant difference in incidence of hepatorenal syndrome , which was less frequent in the group receiving pentoxifylline . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01214226 AIM To compare the efficacy of pentoxifylline and prednisolone in the treatment of severe alcoholic hepatitis , and to evaluate the role of different liver function scores in predicting prognosis . METHODS Sixty-eight patients with severe alcoholic hepatitis ( Maddrey score > or = 32 ) received pentoxifylline ( n = 34 , group I ) or prednisolone ( n = 34 , group II ) for 28 d in a r and omized double-blind controlled study , and subsequently in an open study ( with a tapering dose of prednisolone ) for a total of 3 mo , and were followed up over a period of 12 mo . RESULTS Twelve patients in group II died at the end of 3 mo in contrast to five patients in group I. The probability of dying at the end of 3 mo was higher in group II as compared to group I ( 35.29 % vs 14.71 % , P = 0.04 ; log rank test ) . Six patients in group II developed hepatorenal syndrome as compared to none in group I. Pentoxifylline was associated with a significantly lower model for end-stage liver disease ( MELD ) score at the end of 28 d of therapy ( 15.53 + /- 3.63 vs 17.78 + /- 4.56 , P = 0.04 ) . Higher baseline Maddrey score was associated with increased mortality . CONCLUSION Reduced mortality , improved risk-benefit profile and renoprotective effects of pentoxifylline compared with prednisolone suggest that pentoxifylline is superior to prednisolone for treatment of severe alcoholic hepatitis BACKGROUND Role of corticosteroids in treatment of  severe alcoholic hepatitis ( SAH ) is controversial . Pentoxifylline ( PTX ) , an inhibitor of TNF , has also been shown to decrease short term mortality in SAH . Aim of this study was to evaluate the effect of PTX on short term mortality , renal and hepatic functions in patients with SAH . METHODS Fifty patients with SAH { Maddrey 's Discriminant Function ( DF ) > or = 32 } were prospect ively enrolled . Twenty five patients received  PTX  ( 400 mg orally , three times a day ) , and 25 received placebo for 4 weeks . Serum tumor necrosis factor ( TNF ) was measured in both groups . RESULTS Baseline characteristics of the two groups were similar . At 4 weeks , mortality in PTX group was lower than that in controls { 20 % ( 5/25 ) versus 40 % ( 10/25 ) respectively ; p = 0.216 ; RR 0.5 ; 95 % CI 0.19 - 1.25}. Renal failure was the cause of mortality in 20 % ( 1/5 ) patients in PTX group , and 70 % ( 7/10 ) in controls ( p = 0.11 ) . Significant reduction in urea , creatinine , DF and TNF was noted in PTX group . Reduction in TNF did not correlate with reduction in creatinine or DF . CONCLUSIONS In patients with SAH , PTX leads to a significant improvement in renal and hepatic functions , and a trend towards decreased short term mortality BACKGROUND / AIMS In severe alcoholic hepatitis ( AH ) , 40 % of patients will obtain no benefit from corticosteroids . Improvement in management of non-responders is warranted and only pentoxifylline can be considered an alternative . A two-step strategy was evaluated consisting of early withdrawal of corticosteroids and a switch to pentoxifylline for 28 additional days in non-responders identified using early change in bilirubin level . METHODS One hundred and twenty-one patients with AH were treated prospect ively with corticosteroids  , and the two-step strategy was proposed to 29 non-responders treated according to a two-step strategy who were compared to 58 matched non-responders treated with corticosteroids only . RESULTS Clinical and biological features of the two groups were similar . There was no survival improvement at 2 months in patients treated with the two-step strategy compared to controls : 35.5+/-6.3 % vs 31+/-8.6 % . After 21 days , biological evolution was similar for prothrombin time ( -0.25s vs + 0.2s ) , bilirubin ( 0.8 mg/dl vs 2.03 mg/dl ) and creatinine ( + 0.16 mg/dl vs -0.7 mg/dl ) . In multivariate analysis , only age , evolution of bilirubin during the first week , creatinine and DF were associated with 2-month survival . CONCLUSIONS Non-responders to corticosteroids do not obtain any benefit from an early switch to pentoxifylline . Thus , the issue of management of non-responders remains unresolved BACKGROUND & AIMS Pentoxifylline , an inhibitor of tumor necrosis factor-alpha , is given to patients with liver diseases , but its effects in patients with advanced cirrhosis are unknown . We performed a r and omized , placebo-controlled , double-blind trial of its effects in patients with cirrhosis . METHODS A total of 335 patients with cirrhosis ( Child-Pugh class C ) were assigned to groups given either pentoxifylline ( 400 mg , orally , 3 times daily ; n = 164 ) or placebo ( n = 171 ) for 6 months . The primary end point was mortality at 2 months . Secondary end points were mortality at 6 months and development of liver-related complications . RESULTS By 2 months , 28 patients in the pentoxifylline group ( 16.5 % ) and 31 in the placebo group ( 18.2 % ) had died ( P = .84 ) . At 6 months , 50 patients in the pentoxifylline group ( 30.0 % ) and 54 in the placebo group ( 31.5 % ) had died ( P = .75 ) . The proportions of patients without complications ( eg , bacterial infection , renal insufficiency , hepatic encephalopathy , or gastrointestinal hemorrhage ) were higher in the pentoxifylline group than in the placebo group at 2 months ( 78.6 % vs 63.4 % ; P = .006 ) and 6 months ( 66.8 % vs 49.7 % ; P = .002 ) . The probability of survival without complications was higher in the pentoxifylline group than in the placebo group at 2 and 6 months ( P = .04 ) . In multivariate analysis , the factors associated with death were age , the Model for End-Stage Liver Disease score , and presence of early-stage carcinoma . Treatment with pentoxifylline was the only factor associated with liver-related complications . CONCLUSIONS Although pentoxifylline does not decrease short-term mortality in patients with advanced cirrhosis , it does reduce the risk of complications Background : Prednisolone and pentoxifylline ( PTX ) have been shown to be individually useful in severe alcoholic hepatitis with Maddrey discriminant function ( MDF ) score ≥32 . Previous report suggests that PTX is probably superior to prednisolone alone . However the efficacy of PTX and prednisolone combination over PTX alone in the management of acute alcoholic hepatitis ( MDF score ≥32 ) is yet unrevealed . Aim : The present study was initiated to find out the efficacy of combined pentoxifylline and prednisolone versus PTX alone in acute alcoholic hepatitis in respect of short and intermediate term outcomes . Subjects and Methods : A total of 124 patients with severe alcoholic hepatitis ( MDF score ≥ 32 ) initially were evaluated . 62 patients who fulfilled the inclusion and exclusion criteria were r and omized and divided into 2 groups . Group 1 received PTX only , whereas Group 2 received PTX plus Prednisolone . The total duration of follow-up was 12 months . Student′s t-test , 
    Output:
    
None of the treatments conferred any medium-term or long-term survival benefits in the present study .
Conclusions : Dual therapy was not inferior to corticosteroid monotherapy and could reduce the incidence of hepatorenal syndrome or acute kidney injury and risk of infection .
Therefore , dual therapy might be considered in treatment of patients with severe alcoholic hepatitis