Efficacy of long-term ezetimibe therapy in patients with nonalcoholic fatty liver disease.
BACKGROUND
Hyperlipidemia, insulin resistance, and oxidative stress can heavily contribute to the initiation and progression of nonalcoholic fatty liver disease (NAFLD). Currently, there is no established treatment for this disease. Recently, several studies have shown that ezetimibe (EZ), a lipid-lowering drug, attenuates liver steatosis in an experimental NAFLD model. This study was designed to assess the efficacy of long-term EZ monotherapy in patients with NAFLD.


METHODS
A total of 45 patients with newly diagnosed liver biopsy-proven NAFLD were treated with EZ (10 mg/day) for 24 months. NAFLD-related biochemical parameters, imaging by computerized tomography, and liver biopsy were studied before and after treatment.


RESULTS
Ezetimibe therapy significantly improved NAFLD-related metabolic parameters including visceral fat area, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-R), triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-Ch), oxidative-LDL, the net electronegative charge modified-LDL, profiles of lipoprotein particle size and fatty acids component, and estimated desaturase activity. EZ therapy also significantly lowered serum alanine aminotransferase and high-sensitivity C-reactive protein levels, whereas no significant changes were found in serum type IV collagen 7S, adiponectin, leptin, and resistin levels. Histological features of steatosis grade (P = 0.0003), necroinflammatory grade (P = 0.0456), ballooning score (P = 0.0253), and NAFLD activity score (NAS) (P = 0.0007) were significantly improved from baseline. However, the fibrosis stage was not significantly (P = 0.6547) changed.


CONCLUSIONS
The results in this study suggest that the long-term EZ therapy can lead to improvement in metabolic, biochemical, and histological abnormalities of NAFLD. Therefore, EZ may be a promising agent for treatment of NAFLD.
Park
Hyohun
H
Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, 1-2 Kawazono-cho, Suita, Osaka, 564-0013, Japan.
Shima
Toshihide
T
Yamaguchi
Kanji
K
Mitsuyoshi
Hironori
H
Minami
Masahito
M
Yasui
Kohichiroh
K
Itoh
Yoshito
Y
Yoshikawa
Toshikazu
T
Fukui
Michiaki
M
Hasegawa
Goji
G
Nakamura
Naoto
N
Ohta
Mitsuhiro
M
Obayashi
Hiroshi
H
Okanoue
Takeshi
T
D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001384:Azetidines / Q000008:administration & dosage / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004334:Drug Administration Schedule; D000069438:Ezetimibe; D005234:Fatty Liver / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000145:classification / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D001384:Azetidines; D015415:Biomarkers; D000069438:Ezetimibe