The role of Ursodeoxycholic acid in non-alcoholic steatohepatitis: a systematic review

Abstract

BackgroundNon-alcoholic steatohepatitis (NASH) is a condition that occurs during the progression of non-alcoholic fatty liver disease. Effective therapy for NASH is still lacking. In this study, we investigated the effects of Ursodeoxycholic acid (UDCA) in the treatment of NASH.MethodsWestern and Chinese databases were searched by independent investigators using appropriate MESH headings to identify randomized, controlled Western and Chinese clinical trials, published between January 1990 and October 2012, testing the effects of UDCA in patients with NASH. Patient characteristics and trial endpoints were analyzed, with quality assessment according to widely acknowledged criteria. P < 0.05 was defined as statistically significant in all trials.ResultsTwelve qualified randomized clinical trials, including six from China and involving 1160 subjects, were selected. Seven of these trials assessed the effects of UDCA Monotherapy, with the other five testing combinations of UDCA with vitamin E, polyene phosphatidylcholine, silymarin, glycyrrhizin and tiopronin. The duration of therapy ranged from 3 to 24 months, with two studies using high doses of UDCA (23–35 mg/kg/d). The average quality point was 2.69, and was significantly lower in articles from China than in those from Western countries (2.2 ± 0.4 vs. 3.8 ± 1.1, respectively, p < 0.05). UDCA Monotherapy significantly improved liver function in five studies and improved steatosis and fibrosis in two studies. All five studies assessing UDCA combination therapy showed significant improvements liver function, while two studies also improved steatosis and inflammation. One study of high-dose UDCA showed significant improvements in ALT, γGT and liver fibrosis, whereas the other study showed no significant change in ALT and liver pathology.ConclusionsUDCA therapy is effective in NASH, especially when combined with other drugs. However, the low quality of these studies and the heterogeneity of their results precluded further meta-analysis. Additional carefully designed clinical trials are needed, especially in China.

Modern Approaches to the Treatment of Hypercholesterolemia in Coronary Heart Disease Patients With Metabolic Syndrome and Chronic Non-Alcoholic Steatohepatitis

“…Results. After 30 days of therapy there was sugnificant lowering of ALT from 83,61 (1,81,5,49) to 51,32 (2,41,5,76) МЕ/l,44 (2,02,4,23) to 42,12 (1,99,6,32) МЕ/l (mediana). In 7 patients levels of ALT and AST were normal.…”

“…Нако-пленные в настоящее время данные убедительно ука-зывают на то, что в патогенезе атерогенной дислипи-демии немаловажную роль играет печень. Но печень не только инициирует нарушения липидного обмена, но и выступает в роли мишени дислипидемии [3,4]. Наиболее частой формой повреждения печени у пациентов ИБС с гиперхолестеринемией является неалкогольная жировая болезнь печени (НАЖБП).…”

Non-Alcoholic Fatty Liver Disease: The Effect of Bile Acids and Farnesoid X Receptor Agonists on Pathophysiology and Treatment

“…One of the original bile acids used clinically for NASH was ursodeoxycholic acid (UCDA). This has been comprehensively reviewed elsewhere, 71,72 but earlier studies did not report an improvement in liver histology or liver enzymes after 2 years of treatment at a low dose of 13-15 mg/kg 73 or 6 months at a high dose of 28-32 mg/kg, 74 but was effective at a high dose after 1 year of treatment. 75 Whilst the long term benefit of UCDA requires confirmation, a taurine conjugate of UCDA called tauroursodeoxycholic acid may have potential use, as this has shown to prevent NASH progression by decreasing endoplasmic reticulum stress.…”

Modern Aspects of Treatment of Non-Alcoholic Fatty Liver Disease

“…Прием урсо-дезоксихолевой кислоты в дозе 15-30 мг/кг массы тела ежедневно в течение 24-48 недель приводит к досто-верному снижению активности сывороточных трансами-наз [19]. Однако убедительных данных о положительном влиянии УДХК на некровоспалительные изменения и фиброз печени, а также на долгосрочный прогноз паци-ентов с НАЖБП не получено [7].…”