Further studies of propylthiouracil in alcoholic liver disease appear warranted

A recent trial [see Inpharma 619: 6, 9 Jan 1988] showed patients with alcoholic liver disease on propylthiouracil had a significantly lower mortality rate over a 2-year period, compared with placebo (13 vs 25"10) . However, the mortality rate was further decreased in a subgroup of seriously ill patients (55 to 25"10) .

These results are promising but should be viewed with caution . It should be noted that patients in the study had varying degrees of illness from slight liver damage to severe alcoholic hepatitis.

Retrospectively, patients were grouped into those with a good (n = 213) or poor prognosis (97). The low death rate in the former group (7) made it difficult to assess any possible therapeutic effect of propylthiouracil. Patients classified as having a poor prognosis had a reduced mortality rate with treatment but most deaths occurfed within the first 12 weeks of the trial. After 3 months, the number of deaths in the 2 groups were not significantly different, indicating a protective effect of propylthiouracil primarily in acute alcoholic hepatitis. Assessment of the therapeutic potential of propylthiouracil is further complicated by the high withdrawal rate of patients in this study (61"10) . In contrast, an earlier study reported no reduction in the mortality of

~ propylthiouracil-treated patients with acute alcoholic liver disease.

Thus, it appears from recent studies of propylthiouracil that there is " , , a high-risk group who might benefit from this drug, and future studies should be directed towards such patients',

I· Lancet 1: 450, 27 Feb 1988 6309 ,

0156-2703/ 88/ 0319-0003/ 0$01.00/ 0 © ADIS Press INPHARMA'" 19 March 1988 3