Antibody-Mediated Rejection of Solid-Organ Allografts.

The authors reply: Caputo and colleagues agree with us that short-acting benzodiazepines are the cornerstone for treating patients with the alcohol withdrawal syndrome. They suggest that we ought to have included sodium oxybate (the sodium salt of γ-hydroxybutyric acid [GHB]) among the alternative therapies. Sodium oxybate is approved for the treatment of the alcohol withdrawal syndrome in Italy and Austria and for the treatment of narcolepsy in the United States.1 In addition to space constraints, we did not include sodium oxybate among the potential alternative treatments, mainly because of its potential for abuse and its adverse-effect profile.2 In addition to the references cited by Caputo and colleagues, a recent article published after our manuscript went to press reported pooled data from 3436 patients with alcohol dependence and a pharmacovigilance database involving more than 260,000 patients with alcohol dependence who had been treated with sodium oxybate with very few adverse side effects and only a few cases of abuse.1 In a review article published 20 years ago in the Journal, another Italian researcher argued for the inclusion of GHB as a potential treatment for the alcohol withdrawal syndrome and for relapse prevention.3 We believe that benzodiazepines are the drug of choice and that sodium oxybate could be considered, at best, as an option for treatment when other established medications are not appropriate. Rathi and colleagues share their perspective on the treatment of alcoholic hepatitis. This is a matter that we did not discuss in our article because we believed it was beyond its scope. We agree with Rathi and colleagues that there is a need for exploration of new therapies beyond glucocorticoids and pentoxifylline, given that, as we noted in our article, patients with alcoholic hepatitis have a poor prognosis and very few patients will eventually benefit from liver transplantation.