Use of complementary and alternative medicine in patients with liver disease

Strader, Doris B.; Bacon, Bruce R.; Lindsay, Karen L.; Brecque, Douglas R. La; Morgan, Timothy R.; Wright, Elizabeth C.; Allen, Jeff; Khokar, M Farooq; Hoofnagle, Jay H.; Seeff, Leonard B.

doi:10.1111/j.1572-0241.2002.05993.x

Cited by 145 publications

(92 citation statements)

References 12 publications

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“…20 Milk thistle, the active ingredient of which is silybum marianum, is the most commonly used herbal among liver disease patients. 21 Silybum has hepatoprotective effects in animal models of liver disease, specifically preventing the formation of superoxide anions, nitric oxide, tumor necrosis factor (TNF)-␣, and leukotriene B4. [22][23][24] In clinical studies, milk thistle, glycyrrhiza glabra (licorice) and sho-saiko-to (a Japanese Kampo formula consisting of 7 different herbals) have been reported to decrease ALT levels, improve histological stage, and improve symptoms in patients with several liver diseases.…”

Section: Management Of the Difficult-to-treat Patients With Hepatitis Cmentioning

confidence: 99%

Understudied populations with hepatitis C

Strader

2002

Hepatology

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Managing patients with hepatitis C virus (HCV) infection consists primarily of antiviral treatment, currently with peginterferon and ribavirin. Unfortunately, treatment recommendations derive largely from trials that have focused on highly selected patient populations. As a consequence of the strict inclusion and exclusion criteria in these studies, more than half of all HCV-infected patients would be ineligible for enrollment. Even among the selected patients enrolled into studies, only 50% achieve a sustained virological response (SVR).Patients not eligible for current therapies include those with mild disease and normal alanine aminotransferase (ALT) levels, patients with advanced and decompensated liver disease, children, the elderly, patients with ongoing or recent alcohol and substance abuse, renal disease, human immunodeficiency virus ( H epatitis C is an important cause of acute and chronic liver disease worldwide and the most common indication for liver transplantation in adults in the United States. Since the discovery of the hepatitis C virus (HCV) in 1989 and its linkage to non-A, non-B hepatitis, there have been major advances in knowledge of the incidence and prevalence of this infection, its clinical manifestations, natural history, molecular virology, histopathology, and treatment. At present, the management of patients with hepatitis C focuses largely on combination antiviral treatment using a 24-or 48-week course of peginterferon and ribavirin. Two large trials evaluating the safety and efficacy of this combination therapy have demonstrated sustained virological responses (SVR) in slightly more than 50% of patients. 1,2 It is important to stress, however, that response rates of 50% in randomized, controlled trials of therapy do not guarantee that 50% of all patients with chronic hepatitis C can be or will be successfully treated. Patients enrolled in the registration trials of combination therapy were highly selected and not fully representative of the broader population of patients with chronic HCV infection. The strict inclusion and exclusion criteria used in registration trials often exclude populations that have high rates of hepatitis C. Furthermore, chronic hepatitis C is common in populations that are not reached by clinical trials of new and investigational therapies. Because patients enrolled in registration trials of new antiviral treatments are a selected group, the applicability of results of these trials to the general population is problematic.

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Section: Management Of the Difficult-to-treat Patients With Hepatitis Cmentioning

confidence: 99%

Understudied populations with hepatitis C

Strader

2002

Hepatology

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“…Among 809 patients who completed the questionnaire, 41% (range 33% to 75% at the 6 institutions) indicated that they had used some form of CAM at least once during the preceding month. 5 Herbal preparations were taken by 12% to 50% (median, 20%) of patients. The most common herbal taken for liver disease was milk thistle (silymarin), reported by 12% of respondents.…”

Section: Use Of Cam By Patients In Liver Disease Clinicsmentioning

confidence: 99%

Complementary and alternative medicine in chronic liver disease

et al. 2001

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“…Thus, there are many patients who have no other Food and Drug Administration-approved options to eliminate HCV and prevent progression of liver disease. As a result, many individuals have opted for complementary and alternative medicine-based approaches, including botanicals, to treat their chronic hepatitis C. Indeed, as many as 13 to 23% of American patients with chronic liver disease use botanical medicines, with silymarin being the most popular (6,7).…”

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Identification of hepatoprotective flavonolignans from silymarin

Polyak

Morishima

Lohmann

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

282

223

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Silymarin, also known as milk thistle extract, inhibits hepatitis C virus (HCV) infection and also displays antioxidant, anti-inflammatory, and immunomodulatory actions that contribute to its hepatoprotective effects. In the current study, we evaluated the hepatoprotective actions of the seven major flavonolignans and one flavonoid that comprise silymarin. Activities tested included inhibition of: HCV cell culture infection, NS5B polymerase activity, TNF-α-induced NF-κB transcription, virus-induced oxidative stress, and T-cell proliferation. All compounds were well tolerated by Huh7 human hepatoma cells up to 80 μM, except for isosilybin B, which was toxic to cells above 10 μM. Select compounds had stronger hepatoprotective functions than silymarin in all assays tested except in T cell proliferation. Pure compounds inhibited JFH-1 NS5B polymerase but only at concentrations above 300 μM. Silymarin suppressed TNF-α activation of NF-κB dependent transcription, which involved partial inhibition of IκB and RelA/p65 serine phosphorylation, and p50 and p65 nuclear translocation, without affecting binding of p50 and p65 to DNA. All compounds blocked JFH-1 virus-induced oxidative stress, including compounds that lacked antiviral activity. The most potent compounds across multiple assays were taxifolin, isosilybin A, silybin A, silybin B, and silibinin, a mixture of silybin A and silybin B. The data suggest that silymarin-and silymarin-derived compounds may influence HCV disease course in some patients. Studies where standardized silymarin is dosed to identify specific clinical endpoints are urgently needed.hepatitis C | liver disease | milk thistle | botanical medicine | hepatoprotection C hronic hepatitis C virus (HCV) is a major global medical problem. In the United States, millions of people are affected, the number of patients with HCV-induced end-stage liver disease is growing (1), and this condition is already the leading indication for liver transplantation (2). The current standard of care for chronic hepatitis C, pegylated IFN-α and ribavirin, results in sustained elimination of virus in 55% of treated patients (3, 4). However, significant numbers of patients do not clear the virus and are intolerant to, have contraindications to, or opt out of therapy. Furthermore, because emerging specifically targeted antiviral therapy for HCV therapies need to be administered with pegylated IFN plus ribavirin (5), it is likely that many patients will not tolerate this therapy. Thus, there are many patients who have no other Food and Drug Administration-approved options to eliminate HCV and prevent progression of liver disease. As a result, many individuals have opted for complementary and alternative medicine-based approaches, including botanicals, to treat their chronic hepatitis C. Indeed, as many as 13 to 23% of American patients with chronic liver disease use botanical medicines, with silymarin being the most popular (6, 7).Silymarin, an extract from the seeds of the milk thistle plant, Silybum marianum, has been used fo...

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Use of complementary and alternative medicine in patients with liver disease

Abstract: CAM use is as common among patients visiting liver disease clinics in the United States as in the general population (39% vs 42%). Many patients are using herbs to treat their liver disease but are declining to discuss this use with their physician.

Cited by 145 publications

References 12 publications

Understudied populations with hepatitis C

Understudied populations with hepatitis C

Complementary and alternative medicine in chronic liver disease

Identification of hepatoprotective flavonolignans from silymarin

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