A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients.
BACKGROUND
Treatment options for non-alcoholic steatohepatitis (NASH) are limited. Weight loss remains the most recommended therapy. Orlistat is an effective adjunct to dietary weight loss therapy.


OBJECTIVE
To evaluate the efficacy of orlistat, given for 6 months to patients with obesity and biopsy confirmed NASH.


METHODS
Ten obese patients with biopsy proven NASH were enrolled. Orlistat was given with meals for 6 months. Body Mass Index (BMI), liver enzymes, haemoglobin A1c, fasting lipids and glucose were assessed at baseline and at completion of the study. Paired liver histology was obtained.


RESULTS
Six women and four men were enrolled. The mean weight loss was 22.7 lb and ranged from 0 to 24.3%. The following clinical values significantly improved: mean BMI: 43.4-39.8 (P = 0.007); mean haemoglobin A1c (%): 7.14-5.95 (P = 0.021); mean alanine aminotransferase (ALT) (U/L): 93 -54 (P = 0.009); and mean aspartate aminotransferase (AST) (U/L): 79-48 (P = 0.008). Steatosis improved in six patients, and fibrosis improved in three patients.


CONCLUSIONS
Orlistat therapy and dietary counselling were associated with significant decreases in body weight, haemoglobin A1c, ALT and AST. A 10% or greater reduction in weight improved steatosis and fibrosis as well as haemoglobin A1c levels in the majority of patients treated for 6 months. Controlled trials of longer duration are warranted to assess for histopathologic improvement as well as cost-efficacy in comparison to diet and exercise alone.
Harrison
S A
SA
Department of Gastroenterology, Brooke Army Medical Center, San Antonio, TX 78234, USA. stephen.harrison@cen.amedd.army.mil
Fincke
C
C
Helinski
D
D
Torgerson
S
S
Hayashi
P
P
D000368:Aged; D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy*; D000077403:Orlistat; D015431:Weight Loss
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat