Prednisolone,
does it really help with Reduction of 28-day, 90-day, and one-year mortality in severe alcohol-related hepatitis?
research showsIn 1,103 STOPAH participants, 28-day mortality showed a borderline signal, but there was no benefit at 90 days or one year and infections increased; the conflicting-large-trial rule yields C with 46 points. An individual-patient-data meta-analysis supports lower 28-day mortality, so a completely ineffective D would be too harsh. Yet the prespecified STOPAH analysis was borderline, there was no 90-day or one-year benefit, and infection harm prevents a rating above C. This indication is entirely different from the A-rated prednisolone verdict 1183 for Bell palsy.
ads claimMarketing or simplified guideline summaries can state that steroids improve survival without specifying time. Even the most favorable evidence concerns a selected severe population and short-term 28-day benefit, not improved survival at 90 days or one year.
Useful facts when choosing a product
- The trial regimen was generally prednisolone 40 mg once daily for 28 days, but specialist assessment determines eligibility and discontinuation in the presence of infection, bleeding, renal failure, or other complications.
- Infection should be sought before treatment and monitored during therapy; prednisolone can increase susceptibility to infection and infection-related mortality.
- Hyperglycemia, fluid retention, psychiatric effects, muscle weakness, and gastrointestinal bleeding can occur.
- Clinical practice uses the Lille score around day 7 to identify nonresponse and reduce unnecessary exposure.
What the research actually shows
STOPAH randomized 1,103 patients with severe alcohol-related hepatitis in a 2-by-2 factorial design to prednisolone, pentoxifylline, both, or neither. In the prednisolone comparison, 28-day mortality was 73 of 526 patients (14%) versus 95 of 527 (18%), OR 0.72 (95% CI 0.52 to 1.01), p=0.06, making the prespecified unadjusted analysis borderline. A post hoc multivariable adjustment was significant, but 90-day death or transplantation and one-year death or transplantation showed no benefit, with ORs of 1.02 and 1.01. Serious and post-treatment infections increased. A later individual-patient-data meta-analysis supported a 28-day survival benefit but no six-month benefit, leaving a short-term signal alongside medium-term failure.
Why this is classified as C (46)
Twenty-eight-day mortality in large STOPAH was borderline, with adjusted analysis and meta-analysis strengthening only the short-term signal. No benefit on 90-day or one-year hard endpoints plus increased infection meets the conflicting-large-trial boundary, yielding C with 46 points.
Counterpoint. An individual-patient-data meta-analysis supports lower 28-day mortality, so a completely ineffective D would be too harsh. Yet the prespecified STOPAH analysis was borderline, there was no 90-day or one-year benefit, and infection harm prevents a rating above C. This indication is entirely different from the A-rated prednisolone verdict 1183 for Bell palsy.
Rejudgment record. Cross-check applied — Rated C by accepting the borderline 28-day STOPAH signal and later meta-analysis while applying the conflicting-large-trial rule for no benefit at 90 days or one year and increased infection
Sub-claim grades by effect
This ingredient is marketed for several effects. A single overall grade blends strong and weak claims together, so each effect is graded separately here. The overall grade reflects the strongest disconfirming or core claim.
| Effect (sub-claim) | Grade | Basis |
|---|---|---|
| Reduction in 28-day mortality | C | The unadjusted STOPAH analysis was borderline at OR 0.72, p=0.06, while an individual-patient-data meta-analysis supported short-term benefit. |
| Reduction in 90-day mortality | D | STOPAH showed no benefit for 90-day death or transplantation, OR 1.02. |
| Reduction in one-year mortality | D | STOPAH showed no benefit for one-year death or transplantation, OR 1.01. |
Cross-check — Codex and Claude
Evidence Table
| Study | Design | Sample | Funding | Endpoint | Result | Weight |
|---|---|---|---|---|---|---|
| Thursz MR et al. STOPAH. 2015 | Multicenter randomized double-blind 2-by-2 factorial trial | 1,103 | Supported by the UK NIHR; study drugs partly supplied | Death or transplantation at 28 days, 90 days, and one year | 28-day OR 0.72 (95% CI 0.52 to 1.01), p=0.06; 90-day OR 1.02; one-year OR 1.01. | Key conflicting large hard-endpoint trial |
| Louvet A et al. 2018 | Individual-patient-data meta-analysis of four controlled trials | Academic multicenter research | 28-day and six-month mortality | Corticosteroids versus control: 28-day HR 0.64 (95% CI 0.48 to 0.86), no six-month difference. | Supports short-term signal but not durability |
Receipt — 3 References
All 3 cited sources were verified for existence at the original page (as of 2026-07-23).
Reviewed and approved: Chamgap Editorial Team · Approval date: 2026-07-23 · Corrections: none
Cite this verdict
[Chamgap] Prednisolone x reduction of 28-day, 90-day, and one-year mortality in severe alcohol-related hepatitis — Evidence Grade C·46. 3 cited sources checked. Source: https://chamgap.com/en/verdicts/liver/prednisolone-severe-alcohol-related-hepatitis-mortality/ · CC BY 4.0CC BY 4.0 — free to use with attribution; do not distort grades, numbers, or verdict meaning.
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Chamgap is an information source. It reports what research has and has not confirmed; it does not tell readers what to take or buy. That decision belongs to readers and, when needed, medical or legal professionals. This verdict reflects literature available up to the search date and may change as new research appears. Nothing here is medical advice.