Beneficial effects of pentoxifylline on hepatic steatosis, fibrosis and necroinflammation in patients with non-alcoholic steatohepatitis.
OBJECTIVE
Inhibition of tumor necrosis factor (TNF)-alpha is a logical approach to manage patients with non-alcoholic steatohepatitis (NASH). Pentoxifylline reduces TNF-alpha and alanine aminotransferase (ALT) levels in patients with NASH. The aim of the present paper was to study if pentoxifylline can improve histological injury in patients with NASH.


METHODS
Nine patients (mean age 31.6 +/- 7.2 years) with histologically proven NASH and with persistently elevated ALT (>1.5 times) were given pentoxyfylline at a dosage of 400 mg t.i.d. for 12 months. Besides biochemical assessment, a repeat liver biopsy was performed and the degree of inflammation and fibrosis was compared.


RESULTS
After 12 months of therapy a significant reduction in ALT (111 +/- 53 IU/L vs 45 +/- 19 IU/L, P = 0.003) and aspartate aminotransferase (AST) (61 +/- 27 IU/L vs 33 +/- 12 IU/L, P = 0.005) levels was observed. Steatosis and lobular inflammation each reduced in 55% and six (67%) patients down-staged on Brunt's staging (P = 0.009). Four out of six patients with baseline fibrosis had reduction in their fibrosis stage.


CONCLUSIONS
Long-term pentoxyfylline therapy effectively achieves sustained biochemical improvement. This correlates well with histological resolution of the disease.
Satapathy
Sanjaya K
SK
Department of Gastroenterology, GB Plant Hospital, New Delhi, India.
Sakhuja
Puja
P
Malhotra
Veena
V
Sharma
Barjesh C
BC
Sarin
Shiv K
SK
D000284:Administration, Oral; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005234:Fatty Liver / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D005260:Female; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000473:pathology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000201:enzymology / Q000209:etiology / Q000473:pathology; D008297:Male; D009336:Necrosis; D010431:Pentoxifylline / Q000008:administration & dosage / Q000627:therapeutic use*; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D020011:Protective Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D010431:Pentoxifylline