Disulfiram therapy in patients with hepatitis C: a 12-month, controlled, follow-up study.
OBJECTIVE
Although abstinence slows liver injury in alcoholic Hepatitis C (HCV) infected patients, few clinicians prescribe disulfiram because of concern over its hepatotoxic effect. Finding no controlled studies on this effect, we investigated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) patterns in seropositive (HCV[+]) and seronegative (HCV[-]) patients who received supervised disulfiram over 12 months.


METHODS
We recorded retrospective aminotransferase measurements from medical records of 26 HCV(+) and 20 HCV(-) cases receiving 1500 mg disulfiram weekly in divided doses. Within groups, paired mean AST and ALT levels at 3, 6, 9 and 12 months were compared with baseline; between groups, nonpaired mean comparisons were used.


RESULTS
There were no statistically or clinically significant elevations for the HCV(+) group at any time point. Between-group means were identical at all time points.


CONCLUSIONS
Although sample size and retrospective design invite replication, the data suggest that disulfiram may be useful for HCV(+) alcohol-dependent patients in slowing hepatic injury by eliminating alcohol use and thereby removing the purported alcohol-HCV hepatotoxic synergy. It may also help to establish the abstinence criteria necessary to qualify for antiviral treatment. If disulfiram is used in HCV treatment, AST and ALT must be monitored closely.
Martin
Brandon
B
Denver Veterans Affairs Medical Center, 1055 Clermont Street, Denver, Colorado 80220, USA.
Alfers
Julie
J
Kulig
Clark
C
Clapp
Lori
L
Bialkowski
Diana
D
Bridgeford
Denise
D
Beresford
Thomas P
TP
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D016009:Chi-Square Distribution; D004221:Disulfiram / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000097:blood* / Q000188:drug therapy* / Q000201:enzymology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D004221:Disulfiram