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An RCT of 174 patients with severe alcoholic hepatitis found that the combination of prednisolone + NAC (IV for 5 days, then oral for 2 weeks) significantly reduced 1-month mortality compared to prednisolone alone (8% vs 24%, p=0.006), though the difference was not significant at 6 months (Nguyen-Khac et al., N Engl J Med, 2011) [36]

This paradox (tumor-suppressive role in initiation but oncogenic role in progression) highlights the dual role of RIPK3 and emphasizes the need for expression-based patient stratification in future therapeutic strategies (135)