A Randomized Controlled Trial of Glycyrrhizin Plus Tenofovir vs. Tenofovir in Chronic Hepatitis B with Severe Acute Exacerbation

Abstract

Objectives:Severe acute exacerbation (SAE) of chronic hepatitis B (CHB) may progress to liver failure with high potential mortality despite the prompt treatment with nucleos(t)ide analogs. This study aimed to evaluate the efficacy and safety of glycyrrhizin in the treatment of CHB with SAE.Methods:Sixty patients with SAE of CHB were randomly treated with tenofovir plus intravenous glycyrrhizin (group A, n=30) or with tenofovir alone (group B, n=30). Primary end points were the improvement of serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and model for end-stage liver disease (MELD) score. Secondary end point was overall mortality or receipt of liver transplantation by week 24.Results:Patients in group A had significant reductions of serum AST and ALT levels from baseline at days 3, 5, 8, and 15 than those in group B (all P<0.05). The MELD score significantly decreased since week 1 in the group A patients, whereas there were no changes relative to baseline in group B patients at weeks 1 and 2. By week 24, one (3.3%) of group A patients and four (13.3%) of group B patients died (n=3) or received liver transplantation (n=1) (P=0.177). Multivariate analysis identified baseline MELD score (P=0.021) as an independent factor for mortality or receipt of liver transplantation. There were no differences in the rates of grade 3 hypertension, hypokalemia and ascites between two groups.Conclusions:Early introduction of glycyrrhizin can be safe and helpful for patients with SAE of CHB.

Risk factors associated with pseudoaldosteronism in patients with chronic hepatitis: A retrospective cohort study

“…Glycyrrhizin (GL) is a major component of licorice root. GL‐containing medications are used as complementary medicines to manage hepatic dysfunction in patients with chronic hepatitis; however, GL has notable side effects. Pseudoaldosteronism is the side effect most frequently associated with GL, which was first described by Conn et al Pseudoaldosteronism is characterized by hypertension, oedema of the extremities and serum hypokalaemia, which are all caused by excessive levels of mineralocorticoid receptor activity …”

Intravenous glycyrrhizin as a rescue therapy in a patient with latent hepatitis B virus reactivation and acute severe decompensation induced by chemotherapy with rituximab

“…It can also interfere with the complement pathways and inhibit phospholipase A2, causing anti‐inflammatory and membrane‐protective effects . In a randomized trial, the early introduction of glycyrrhizin therapy in combination with NUCs was proposed to be beneficial for patients with clinically severe acute exacerbation of chronic hepatitis B . SNMC may be a rescue and bridging therapy choice until viral load begins to decline, owing to its liver protective‐mechanism and good safety.…”

The diagnosis and management of idiosyncratic drug‐induced liver injury

“…An European randomized controlled trial of glycyrrhizin showed improvement in serum ALT and hepatic necroinflammation and fibrosis in patients with chronic hepatitis C who were nonresponders to interferon . Similarly, studies from Asia have shown beneficial effects with glycyrrhizin in patients with chronic hepatitis B …”