Spontaneous Improvement in Severe Alcohol-Related Hepatitis May Not Benefit From Steroids: JHEP Reports | October 2026

What Did the Study Find?

CORTISAVE addressed a specific bedside dilemma: whether to start corticosteroids in biopsy-confirmed severe alcohol-related hepatitis when bilirubin has already fallen by more than 10% within five to ten days of admission. Ten Belgian hospitals randomised 69 such patients to 28 days of methylprednisolone 32 mg daily or placebo.

At 90 days, survival was 79% with steroids versus 83% with placebo; eight versus five patients died. Thirty-day survival was 95% versus 94%. Infection by day 90 occurred in an estimated 47% versus 34%, although that difference was not statistically conclusive. Importantly, recruitment stopped at 69 of the planned 140 participants. The wide survival confidence interval means the study cannot rule out a modest steroid benefit, despite finding none. PubMed

Why Does It Matter?

A falling bilirubin before treatment may identify patients with a better spontaneous trajectory, for whom infection risk weighs more heavily in the decision. These results support reassessing trajectory and contraindications, not withholding steroids from all patients with severe alcohol-related hepatitis.

GastroAGI takeaway: In severe alcohol-related hepatitis that is already improving, pause for individualised risk assessment; CORTISAVE raises doubt about automatic steroids but is too small to settle the question