Am J Gastroenterol

Prednisolone tapering reduces infection risk in alcohol-associated hepatitis

May 5, 2025

A tapered prednisolone regimen may reduce the risk of infections in patients with severe alcohol-associated hepatitis (AAH) without increasing other adverse outcomes. These findings support consideration of a tapered dosing strategy in clinical practice to mitigate infection risk in this patient population.

Study details: The STASH Trial was a multicenter randomized trial that included 254 patients with severe AAH enrolled between March 2023 and August 2024. Patients were randomized to receive either a standard fixed dose of prednisolone (40 mg/day for 4 weeks) or a tapered dose (40 mg/day, reduced by 10 mg/week over 4 weeks). The primary outcome was the incidence of infection by day 90, with secondary outcomes including mortality, acute kidney injury, readmission rates, and adverse events.

Results: Infection incidence by day 90 was significantly lower in the tapered-dose group (19.7%) compared with the fixed-dose group (33.1%), with a hazard ratio (HR) of 0.57 (95% confidence interval [CI- 0.35-0.94; P = 0.03). Microbiologically proven infections were also lower in the tapered-dose group (8.6% vs. 19%). There were no significant differences in mortality, acute kidney injury, hospitalizations, or all-cause adverse events between the groups.

Source:

Kulkarni AV, et al. (2025, March 13). Am J Gastroenterol. Infections in Standard or Tapered Dose of Prednisolone for Alcohol-Associated Hepatitis: A Randomized Trial (STASH Trial). https://pubmed.ncbi.nlm.nih.gov/40079479/