title: Effects and tolerance of silymarin (milk thistle) in chronic hepatitis C virus infection patients: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy and safety of silymarin on chronic hepatitis C virus- (HCV-) infected patients.
  
  
  METHODS
  Randomized controlled trials (RCTs) of silymarin in chronic HCV-infected patients up to April 1, 2014 were systematically identified in PubMed, Ovid, Web of Science, and Cochrane Library databases.
  
  
  RESULTS
  A total of 222 and 167 patients in five RCTs were randomly treated with silymarin (or intravenous silibinin) and placebo, respectively. Serum HCV RNA relatively decreased in patients treated with silymarin compared with those administered with placebo, but no significance was found (P = 0.09). Meta-analysis of patients orally treated with silymarin indicated that the changes of HCV RNA are similar in the two groups (P = 0.19). The effect on alanine aminotransferase (ALT) of oral silymarin is not different from that of placebo (P = 0.45). Improvements in quality-of-life (Short Form-36) in both silymarin and placebo recipients were impressive but relatively identical (P = 0.09).
  
  
  CONCLUSIONS
  Silymarin is well tolerated in chronic HCV-infected patients. However, no evidence of salutary effects of oral silymarin has yet been reported based on intermediate endpoints (ALT and HCV RNA) in this population. Moreover, intravenous administration of silymarin should be further studied.
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Road, Jinshan District, Shanghai 201508, China ; Key Laboratory of Infectious Diseases of State Administration of Traditional Chinese Medicine (Clinical Base), Shanghai 201508, China.
authors.forename: Zongguo
authors.identifier: 0000-0002-6623-4841
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Fudan University Shanghai Cancer Center, Shanghai 200032, China ; Shanghai Medical College, Fudan University, Shanghai 200032, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Zhuang
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Road, Jinshan District, Shanghai 201508, China ; Key Laboratory of Infectious Diseases of State Administration of Traditional Chinese Medicine (Clinical Base), Shanghai 201508, China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Road, Jinshan District, Shanghai 201508, China ; Key Laboratory of Infectious Diseases of State Administration of Traditional Chinese Medicine (Clinical Base), Shanghai 201508, China.
authors.forename: Qingnian
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Road, Jinshan District, Shanghai 201508, China ; Key Laboratory of Infectious Diseases of State Administration of Traditional Chinese Medicine (Clinical Base), Shanghai 201508, China.
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Chen
mesh_terms: D000284:Administration, Oral; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D019317:Evidence-Based Medicine; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D020944:Silybum marianum / Q000737:chemistry*; D008517:Phytotherapy / Q000706:statistics & numerical data*; D015995:Prevalence; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012838:Silymarin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012838:Silymarin