Immunomodulatory effect of isoprinosine and levamisole in chronic active HBV-positive hepatitis

A, Pár; Paál, M; Németh, Pèter; Szekeres, J.; Sipos, József; Jávor, T

doi:10.1016/0168-8278(89)90580-1

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“…At first, when studying the immunological effects of cianidanol, a hepatoprotective flavonoid similar to silymarin, in patients with alcoholic and HBV hepatitis, we found that it not only inhibited lipid peroxidation but also increased lymphoproliferative response and natural killer (NK) cell activity [18][19][20]. Later we published similar observations regarding the indicators of oxidative stress also with silymarin: following 5 weeks of silymarin treatment in patients with chronic hepatitis C and alcoholic liver disease, normalisation of the abnormal values of AST, ALT, LDH and bilirubin occurred in 45%, 29%, 29%, and 55% respectively, while serum carotenoid and glutathione levels increased and plasma MDA decreased [14].…”

Section: Discussionmentioning

confidence: 99%

Effects of silymarin supplementation in patients with chronic hepatitis C receiving PEG-IFN + ribavirin antiviral therapy. A placebo-controlled double blind study

Pár¹,

Röth²,

Miseta³

et al. 2009

Clinical and Experimental Medical Journal

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Objectives: Since oxidative stress may play a pathogenetic role in chronic hepatitis C and the sustained virological response to antiviral therapy is limited in HCV1 genotype infection, a double blind study was performed in HCV1 patients receiving peginterferon + ribavirin treatment, in order to assess the efficacy of supplementation with an antioxidant flavonoid, silymarin. Patients and Methods: 32 naïve HCV1-positive patients with biopsy-proven chronic hepatitis C, to be treated with peginterferon + ribavirin, have been randomised as follows: Group A: 16 patients received antiviral therapy for 6 to 12 months plus placebo for the first 3 months; Group B: 16 patients were treated with peginterferon + ribavirin for 6 to 12 months plus they received 166 mg oral silymarin twice a day for 3 months. Serum alanine aminotransferase and HCV RNA levels, as well as parameters of oxidative stress such as plasma or RBC haemolysate malondialdehyde, superoxide dismutase, glutathione peroxidase, catalase and myeloperoxidase were determined at Months 0, 1, 3, 6, and 12. Sustained virological response as undetectable HCV RNA was evaluated at 24 weeks after the end of therapy. Results: In the silymarin group a more rapid decrease in malondialdehyde levels as well as a marked decrease in superoxide dismutase and an increase in myeloperoxidase activity were found at Month 12. Alanine aminotransferase normalised in 6/16 (vs. control 9/16) cases, and sustained virological response occurred in 3/16 (vs. 7/16) patients. Discussion: Although silymarin supportation to antiviral therapy improved oxidative stress, it could exert any beneficial effect neither on alanine aminotransferase levels nor on sustained virological response. These contradictory findings may be related to randomisation bias as patients in Group B had more negative predictors of response: they were older with higher fibrosis score and even with more severe pre-treatment baseline oxidative stress. Regarding the recently published in vitro experiments with silibinin on HCV replication as well as the newest convincing clinical observations, we suggest further studies with more than threefold doses of silymarin in controlled trials to assess the value of this supplementation in HCV patients receiving antiviral treatment.

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Section: Discussionmentioning

confidence: 99%