Milica Ćulafić1, Sandra Vezmar-Kovačević1, Violeta Dopsaj2, Branislav Oluić3, Nemanja Bidžić4, Branislava Miljković1, Đorđe Ćulafić5. 1. University of Belgrade, Faculty of Pharmacy, Department of Pharmacokinetics and Clinical Pharmacy. 2. University of Belgrade, Faculty of Pharmacy, Clinical Centre of Serbia, Department of Medical Biochemistry, Belgrade. 3. Clinical Center of Serbia, Emergency Center, Belgrade. 4. Clinical Center of Serbia, Clinic for Digestive Surgery, Belgrade. 5. University of Belgrade, School of Medicine, Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology.
Abstract
BACKGROUND: The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with Nash. Setting: Outpatient hepatology clinic. METHODS: A prospective trial was conducted. The first cohort included patients with biopsy-proven Nash, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in Nash group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications. RESULTS: All 33 Nash patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 mmol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA - IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase by 24.0 U/L, 9.1 U/L, 10.8 U/L respectively, was noted. CONCLUSIONS: Pentoxifylline and Metformin may provide possible treatment option in Nash. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived. 2020 Milica Ćulafić, Sandra Vezmar-Kovačević, Violeta Dopsaj, Branislav Oluić, Nemanja Bidžić, Branislava Miljković, Đorđe Ćulafić, published by CEON/CEES.
BACKGROUND: The progression of the nonalcoholic fatty liver disease to nonalcoholic steatohepatitis (NASH) is multifactorial, and there is still a lack of approved medications for its treatment. The study aimed to evaluate the impact of combined treatment with Pentoxifylline and Metformin on biochemical parameters in patients with Nash. Setting: Outpatient hepatology clinic. METHODS: A prospective trial was conducted. The first cohort included patients with biopsy-proven Nash, while the second cohort consisted of patients with biopsy-confirmed NAFLD. Blood tests were checked at baseline and every three months. Pentoxifylline at a dosage of 400 mg t.i.d. and Metformin at the dosage of 500 mg t.i.d. were introduced for six months in Nash group. The impact of the treatment was assessed based on biochemical results after combined treatment with low-cost medications. RESULTS: All 33 Nash patients completed 24 weeks of treatment. We observed significant improvement (p<0.05) of median values after treatment for the following parameters: serum uric acid levels decreased by 51.0 mmol/L, calcium decreased for 0.27 mmoL/L, magnesium showed an increase of 0.11 mmoL/L. Insulin resistance improved as a reduction of HOMA - IR by 1.3 was detected. A significant decrease of median in liver enzymes, alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase by 24.0 U/L, 9.1 U/L, 10.8 U/L respectively, was noted. CONCLUSIONS: Pentoxifylline and Metformin may provide possible treatment option in Nash. Some new potential benefit of the therapy in improving liver function whilst decreasing cardiovascular risk was perceived. 2020 Milica Ćulafić, Sandra Vezmar-Kovačević, Violeta Dopsaj, Branislav Oluić, Nemanja Bidžić, Branislava Miljković, Đorđe Ćulafić, published by CEON/CEES.
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