A critical analysis of studies assessing L-ornithine-L-aspartate (LOLA) in hepatic encephalopathy treatment

Abstract

Although the trials have shown efficacy of LOLA in reducing hyperammonemia of hepatic encephalopathy, sufficient evidence of a significant beneficial effect of LOLA on patients with hepatic encephalopathy was not found. The studies performed in this area were small, with short follow-up periods and half of them showed low methodological quality.

The Pharmabiotic Approach to Treat Hyperammonemia

“…Finally, glutamate converts to glutamine, which detoxifies one ammonia molecule by glutamine synthetase [ 85 , 44 ]. The intravenous and oral administration of l -ornithine- l -aspartate successfully improved venous ammonia levels and cognitive abilities in HE patients [ 45 , 46 ]. However, a clinical trial in patients with acute liver failure did not show any improvement of the arterial ammonia levels compared to a standard treatment [ 86 ].…”

Efficacy of L-Ornithine L-Aspartate for the prevention and Treatment of Hepatic Encephalopathy in Cirrhosis: An Update of the Evidence Base

“…In a second critical analysis published two years later, searches were made of RCTs that were again published in indexed journals as well as in Medline, Cochrane and PubMed databases in which the efficacy of ivLOLA was assessed in patients with cirrhosis and HE. Six trials met inclusion criteria for a total of 623 patients 422 of which had cirrhosis while the remainder had acute liver failure [10].Trial quality was assessed using the Jadad Composite scale. [11] Venous ammonia concentrations decreased in the LOLA treatment group compared to placebo and these decreases were accompanied by significant improvements in the stage of HE assessed by West Haven criteria (Table 1).…”

Hepatic encephalopathy

“…Adjuvant therapy with LOLA, which was proven to reduce ammonia plasma level [130], might shorten hospitalization due to episodes of overt HE [131]. 3 Nutritional support is preferably given intravenously in patients with risk of food aspiration or unable to ingest a sufficient energy and/or nitrogen amount.…”