(Hepatology 2014;60:1956–1961) “
“In uncontrolled clinical studies, ursodeoxycholic acid (UDCA) had a beneficial effect on nonalcoholic selleckchem steatohepatitis (NASH). However, a large controlled trial using UDCA (13-15 mg/kg/day) was unable to confirm these results. Accordingly,
a randomized, placebo-controlled study was initiated with a high dose of UDCA (23-28 mg/kg/day). The allocation of patients and the evaluation of liver histology were performed according to a modified Brunt score and the nonalcoholic fatty liver disease activity score (NAS). With the modified Brunt score, 185 patients with histologically proven NASH were randomized [intention to treat (ITT)], and 147 were treated per protocol (PP). With the NAS, 137 patients were confirmed to have NASH, 48 had borderline NASH, and 1 did not have NASH. The treatment time was 18 months. At entry, the treatment groups were comparable. A second biopsy sample was obtained from 139 of 185 patients (NAS: 107/137). The primary criterion for evaluation was
a change in the liver histology; Peptide 17 the secondary criteria were single histological variables and liver biochemistry. Significant differences in the overall histology could not be detected between the two treatment groups with the modified Brunt score (P = 0.881) or NAS (P = 0.355). Only lobular inflammation improved significantly (P for the modified Brunt score = 0.011, P for NAS = 0.005). In subgroup analyses, significant improvements in lobular inflammation were also observed in males, younger patients up to 50 years of age, slightly overweight patients, and patients with hypertension and an increased histology score. The fibrosis score did not change (P for ITT = 0.133, P for PP = 0.140). With the exception of γ-glutamyl transferase, UDCA
did not improve laboratory data. Conclusion: High-dose UDCA failed to improve the overall histology in patients with NASH in comparison with placebo. Hepatology 2010 Histologically, nonalcoholic steatohepatitis (NASH) has been characterized by steatosis, ballooning of hepatocytes, lobular and portal tract inflammation, fibrosis, the absence of lipogranulomas, others glycogenated nuclei, and Mallory-Denk bodies. Currently, the definition of NASH is based on three variables significantly associated with the diagnosis of NASH: steatosis, ballooning, and lobular/portal inflammation.1 Lobular fibrosis, portal/periportal fibrosis, bridging fibrosis, and cirrhosis characterize the staging of NASH.1 The nonalcoholic fatty liver disease activity score (NAS) is the sum of the steatosis, lobular inflammation, and hepatocellular ballooning scores.2 In therapy studies, the NAS allows an assessment of overall histological changes. Imaging procedures and routine laboratory data are not diagnostic. NASH is often associated with type 2 diabetes and dyslipidemia.