Is herbal medicine effective in the management of patients with chronic hepatitis C?

Many thanks for providing us with the opportunity to discuss our article entitled: Effects of silybum marianum on patients with chronic hepatitis C virus (HCV).1

We were glad to receive Dr. Alavian's comment entitled “Herbal medicine and liver disease, for any conclusion we need more studies”. HCV is a major cause of liver-related morbidity and mortality.2 Ribavirin plus interferon combination therapy is presently considered as an optimal treatment for patients with chronic hepatitis C, but the recommended treatment regimen is concerned with considerable expense, adverse effects and poor efficacy in some patients. Although the popularity of silymarin has been increased in people with liver diseases,34 a few evidences with controversial results exist regarding the effect of silymarin on chronic HCV infection.

Comment

According to critical opinions of the author that the result of HCV RNA seroconverted to negative was very amazing, it should be mentioned that our sample size was small (55 cases) and the 16.4% negative rate could be due to chance. We calculated 95% confidence interval (CI) which was from 7.8% to 28.8% that means the 16.4% point estimate may be due to random error.

All of the patients enrolled in our study were non cirrhotic and HIV negative. Their sonography reports were near normal. Because liver biopsy is an invasive method and many patients did not have any indication to do this, we assessed liver fibrosis including YKL-40 and Hyaluronic acid.5 The cause of death in one patient was not related to liver diseases or the prescribed herbal drug. Finally, we declare that our trial was open labeled (phase 2) and we recommend further researches especially blinded randomized placebo controlled clinical trials to clarify this issue.