A PROSPECTIVE OBSERVATIONAL STUDY ON EFFECTS OF HEPATOPROTECTIVE AGENTS IN ALCOHOLIC LIVER DISEASE AT A TERTIARY CARE HOSPITAL

Drug utilization evaluation of hepatoprotective drugs is important in view of the spectrum of effect and associated risks with their therapy. The study was designed to evaluate the effects and adverse effects of hepatoprotective agents. A prospective, observational study was carried out for a period of 6 months at Osmania General Hospital (a tertiary care hospital). 120 patients were evaluated receiving corticosteroids, pentoxifylline, ursodeoxycholic acid for observing a trend in hepatic parameters and its outcomes. Ursodeoxycholic acid (81.66%) was the most commonly prescribed drug in almost all cases of alcoholic liver diseases followed by pentoxifylline (10%) in hepatorenal syndrome and then prednisolone (8.33%) in fatty liver. 67 cases were reported to have the significant drop in liver transaminases and bilirubin levels. Ursodeoxycholic acid resulted in a drop of 25% serum bilirubin and 35% drop in serum ALT (alanine transaminase) and 33% drop in serum AST (aspartate transaminase) in patients in a time gap of 1 week. Among 120 cases 94 were males (78.05%) and 26 females (21.04%) and maximum patients with alcoholic liver disease belonged to age group of 30-40 years (27.6%). Ursodeoxycholic acid (300 mg once daily) is used as an off-label drug for all types of alcoholic liver disease and also for viral hepatitis. Though Ursodeoxycholic acid showed a significant drop in liver transaminases and serum bilirubin levels in cirrhotic patients a better alternative lie in liver transplantation as long as they remain abstinent from alcohol. Keywords: Alcoholic liver diseases, Hepatoprotective agents, Liver transaminases, Bilirubin, Paired t-test.

[1]  L. Vale,et al.  The clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis (STOPAH): a 2 × 2 factorial randomised controlled trial. , 2015, Health technology assessment.

[2]  L. Leggio,et al.  Pharmacotherapy for alcoholic patients with alcoholic liver disease. , 2014, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[3]  J. Fenkel,et al.  Treatment of severe alcoholic hepatitis with corticosteroids and pentoxifylline. , 2013, JAMA.

[4]  T. Roskams,et al.  EASL clinical practical guidelines: management of alcoholic liver disease. , 2012, Journal of hepatology.

[5]  M. Kotb Molecular Mechanisms of Ursodeoxycholic Acid Toxicity & Side Effects: Ursodeoxycholic Acid Freezes Regeneration & Induces Hibernation Mode , 2012, International journal of molecular sciences.

[6]  M. Roma,et al.  Ursodeoxycholic acid in cholestasis: linking action mechanisms to therapeutic applications. , 2011, Clinical science.

[7]  P. Deltenre,et al.  Infection in patients with severe alcoholic hepatitis treated with steroids: early response to therapy is the key factor. , 2009, Gastroenterology.

[8]  J. Reichen Review: ursodeoxycholic acid does not reduce risk for mortality or liver transplantation in primary biliary cirrhosis. , 2008, ACP journal club.

[9]  K. Hübner,et al.  Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up , 1985, Digestive Diseases and Sciences.

[10]  A. Hofmann,et al.  Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis part II , 1982, Digestive Diseases and Sciences.

[11]  F. Gudé,et al.  Liver disease in heavy drinkers with and without alcohol withdrawal syndrome. , 2004, Alcoholism, clinical and experimental research.

[12]  B. Borisch,et al.  Rapid changes in alcoholic hepatitis histology under steroids: correlation with soluble intercellular adhesion molecule-1 in hepatic venous blood. , 2001, Journal of hepatology.

[13]  K. Ikejima,et al.  Sex difference in alcohol-related organ injury. , 2001, Alcoholism, clinical and experimental research.

[14]  T. Reynolds,et al.  Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. , 2000, Gastroenterology.

[15]  L. Midanik,et al.  The effect of screening on prevalence estimates of alcohol dependence and social consequences. , 2000, Journal of studies on alcohol.

[16]  P. Cluzel,et al.  Blood neutrophil functions and cytokine release in severe alcoholic hepatitis: effect of corticosteroids. , 2000, Journal of hepatology.

[17]  B. Balkau,et al.  Histopathological study of primary biliary cirrhosis and the effect of ursodeoxycholic acid treatment on histology progression , 1999, Hepatology.

[18]  H Wechsler,et al.  Binge drinking: the five/four measure. , 1998, Journal of studies on alcohol.

[19]  M. R. Jackson,et al.  Heparinoid anticoagulation and topical fibrin sealant in heparin-induced thrombocytopenia. , 1997, The Annals of thoracic surgery.

[20]  T. Sørensen,et al.  Prediction of risk of liver disease by alcohol intake, sex, and age: A prospective population study , 1996, Hepatology.

[21]  U. Steinbrecher,et al.  The canadian multicenter double‐blind randomized controlled trial of ursodeoxycholic acid in primary biliary cirrhosis , 1994, Hepatology.

[22]  A. Hofmann,et al.  Ursodeoxycholic acid in the Ursidae: biliary bile acids of bears, pandas, and related carnivores. , 1993, Journal of lipid research.

[23]  E. Christensen,et al.  Ursodeoxycholic Acid for Primary Biliary Cirrhosis? , 1987, The Cochrane database of systematic reviews.

[24]  M. Morgan Hepatoprotective agents in alcoholic liver disease. , 2009, Acta medica Scandinavica. Supplementum.

[25]  R. Murray,et al.  COMPARISON OF QUESTIONNAIRE AND LABORATORY TESTS IN THE DETECTION OF EXCESSIVE DRINKING AND ALCOHOLISM , 1982, The Lancet.