Bile acid may improve hepatitis C therapy response

By David Douglas

NEW YORK (Reuters Health) - A bile acid - called ursodeoxycholic acid -- may improve response to treatment in patients with chronic hepatitis C virus (HCV) who don't respond to standard therapy with interferon and ribavirin, Japanese researchers report in the medical journal Gut.

Ursodeoxycholic acid is a secondary bile acid that breaks down fat, and reduces the amount of cholesterol produced by the liver and absorbed by the intestines. It also helps break down cholesterol that has formed into gall stones and increases bile flow in patients with primary biliary cirrhosis.

Ursodeoxycholic acid therapy, which reduces levels of a type of enzyme (aminotransferase), may slow the progression of liver fibrosis and prevent the development of liver cancer, Dr. Masao Omata told Reuters Health.

Omata, of the University of Tokyo Graduate School of Medicine, and colleagues note that 1b is the most common HCV strain in Japan and can be resistance even to combination therapy. Only about 50 percent of patients with this HCV type have a sustained response to treatment.

To investigate whether the addition of ursodeoxycholic acid can improve treatment results, the researchers studied 596 patients who had elevated levels of the liver enzyme alanine aminotransferase (ALT). The patients were randomly assigned to receive one of three daily doses of ursodeoxycholic acid for 24 weeks.

ALT, as well as two additional liver enzymes, aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT), decreased at week 4 and then remained constant during drug administration.

Changes in ALT and AST did not differ in the patients who received the two higher doses -- 600 milligrams (mg) or 900 mg -- but GCT was significantly lower in the 900 mg group. In patients with initial GCT levels exceeding 80 IU/L who received 900 mg, ALT also showed a significant decrease.

However, there was no change in blood levels of HCV in any of the groups. Overall, 19.1 percent of patients reported adverse effects, but there were no differences in adverse effects among three groups.