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

Abstract

Latent hepatitis B virus (HBV) reactivation related to rituximab use is associated with an increase in morbidity and mortality. We report a case of latent HBV reactivation with decompensated hepatitis that occurred 10 months after the completion of rituximab therapy. Initially, the patient's condition deteriorated, even during combination antiviral drug therapy (tenofovir plus entecavir). However, it dramatically improved after treatment with intravenous Stronger Neo Minophagen C (SNMC). Glycyrrhizin is the main component of SNMC, which plays a role inbridging therapy to allow the efficiency of antiviral drugs to develop. In addition, prolonged use of the antiviral drug after the completion of rituximab and chemotherapy should be considered to extend beyond 6 months, which is currently advised by the National Health Insurance in Taiwan.

Benefits of stronger Neo‐Minophagen C in acute hepatitis after transarterial chemoembolization therapy for hepatomas

“…Glycyrrhizin has been demonstrated as helpful in lowering or normalizing ALT levels in Asian patients with chronic hepatitis B. 5,6,8 In a European study, glycyrrhizin reduced ALT and improved hepatic necroinflammation and fibrosis in patients with chronic hepatitis C who were nonresponsive or tolerant to previous interferon-based therapies. 10 Additionally, some studies have demonstrated that glycyrrhizin can rapidly improve serum transaminase levels and may prevent progression to severe and fulminant disease in patients with acute chronic hepatitis.…”

“…Glycyrrhizin has been demonstrated as helpful in lowering or normalizing ALT levels in Asian patients with chronic hepatitis B 5,6,8 . In a European study, glycyrrhizin reduced ALT and improved hepatic necroinflammation and fibrosis in patients with chronic hepatitis C who were nonresponsive or tolerant to previous interferon‐based therapies 10 .…”

“…Intravenous SNMC decreases elevated serum alanine aminotransferase (ALT) levels, improves liver function with occasional complete recovery from hepatitis, and reduces the progression of liver disease of various etiologies and degrees. [5][6][7][8][9] The hepatoprotective effects of glycyrrhizin are believed to be related mainly to its anti-inflammatory action.…”

“…In Japan, Stronger Neo‐Minophagen C (SNMC; Minophagen Pharmaceutical, Tokyo, Japan), the active ingredient of which is glycyrrhizin, has been used intravenously to treat chronic hepatitis for over 20 years. Intravenous SNMC decreases elevated serum alanine aminotransferase (ALT) levels, improves liver function with occasional complete recovery from hepatitis, and reduces the progression of liver disease of various etiologies and degrees 5–9 . The hepatoprotective effects of glycyrrhizin are believed to be related mainly to its anti‐inflammatory action.…”