Effectiveness and safety of orally administered silymarin (milk thistle) for pegylated interferon unresponsive chronic delta hepatitis patients Silymarin treatment for pegylated interferon unresponsive chronic delta hepatitis

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Mesut Aydin
Erhan Ergin
Elif Tugba Tuncel
Yaren Dirik
Suat Ozluk
Huseyin Guducuoglu
Ahmet Cumhur Dulger

Abstract

Objective: Silymarin is a natural extract from milk thistle (Silybum marianum), a natural herb that contains flavonoids. Silymarin also has anti-inflammatory properties and lipid peroxidation effects on human hepatocytes. It has also been used for the treatment of acute alpha-amanitin poisoning and chronic hepatitis C infection.  Chronic Hepatitis D virus (HDV) infection is a severe health problem leading to fibrosis and hepatocellular carcinoma. Patients with chronic HDV infection can be treated with Peg-IFN with lower treatment success.  Most patients with chronic HDV are unable or unwilling to use interferon (IFN)-based treatment due to liver cirrhosis. Our objective was to establish the long-term clinical outcomes with silymarin for interferon-experienced chronic HDV patients.


Materials and Methods: We studied ten patients from one centre with interferon who experienced chronic HDV, of which 8 had cirrhosis, and 2 had chronic hepatitis who received HDV treatment with silymarin 600 mg/day after a median period of 12 months. Information collected included demographic, clinical, virologic, and outcomes data. MELD and Child-Pugh (CP) scores were also obtained. Friedman test was used to evaluate the laboratory parameters during the study period.


Results: 10 chronic HDV patients (median age 54 yrs, six female, all of them previous null responders to Peg-IFN  with mildly decompensated cirrhosis [CP 7 (range 6-11), MELD 11 (range 6-20] were followed for 12 months from the start of silymarin 600 mg/day. There was no decompensation of both MELD and CP scores among patients at the end of therapy. In addition, no patients stopped silymarin treatment early due to side effects. At the end of treatment, there was no significant change in prothrombin time (p= 0.949), AST (p=0.662) and AFP (p=0.983) levels and platelets counts (p=0.988) compared to the pre-treatment period (all p>0.005). Finally, HDV-RNA suppression was seen in all patients at the end of treatment (p=0.009).


Conclusions: In the light of the presented data, silymarin seems to be effective in treating chronic HDV infection. Further research is needed for validation. The study is ongoing with a collection of data on sustained viral response.

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How to Cite
Aydin, M., Ergin, E., Tuncel, E. T., Dirik, Y., Ozluk, S., Guducuoglu, H., & Dulger, A. C. (2021). Effectiveness and safety of orally administered silymarin (milk thistle) for pegylated interferon unresponsive chronic delta hepatitis patients: Silymarin treatment for pegylated interferon unresponsive chronic delta hepatitis. Medical Science and Discovery, 8(7), 428–431. https://doi.org/10.36472/msd.v8i7.577
Section
Research Article
Received 2021-07-11
Accepted 2021-07-21
Published 2021-07-22

References

Federico A, Dallio M, Loguercio C. Silymarin/Silybin and Chronic Liver Disease: A Marriage of Many Years. Molecules. 2017;22:191.

Dixit N, Kohli K, Ahmad S, Baboota S, Ali J. Silymarin: A review of pharmacological aspects and bioavailability enhancement approaches. Indian J Pharmacol. 2007;39:172-9.

Bijak M. Silybin, a Major Bioactive Component of Milk Thistle (Silybum marianum L. Gaernt.)-Chemistry, Bioavailability, and Metabolism. Molecules. 2017;22:1942.

Rizzetto M. Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med. 2015;5:a021576.

Rizzetto M, Ponzetto A, Forzani I. Epidemiology of hepatitis delta virus: overview. Prog Clin Biol Res. 1991;364:1-20.

Rizzetto M, Alavian SM. Hepatitis delta: the rediscovery. Clin Liver Dis. 2013;17:475-87.

Liu CH, Jassey A, Hsu HY, Lin LT. Antiviral Activities of Silymarin and Derivatives. Molecules. 2019;24:1552.

Gillessen A, Schmidt HHJ. Silymarin as Supportive Treatment in Liver Diseases: A Narrative Review. Adv Ther. 2020;37:1279-301.

Bahcecioglu IH, Sahin A. Treatment of Delta Hepatitis: Today and in the Future - A review. Infectious Diseases. 2017;49:241-50.

Ferenci P, Scherzer TM, Kerschner H, Rutter K, Beinhardt S, Hofer H, Schöniger-Hekele M, Holzmann H, Steindl-Munda P. Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy. Gastroenterology 2008;135:1561-67.

Ni X, Wang H. Silymarin attenuated hepatic steatosis through regulation of lipid metabolism and oxidative stress in a mouse model of non-alcoholic fatty liver disease (NAFLD). Am J Transl Res. 2016;8:1073-81.

Song Z, Deaciuc I, Song M, Lee DY, Liu Y, Ji X, McClain C. Silymarin protects against acute ethanol-induced hepatotoxicity in mice. Alcohol Clin Exp Res. 2006;30:407-13.

de Avelar CR, Pereira EM, de Farias Costa PR, de Jesus RP, de Oliveira LPM. Effect of silymarin on biochemical indicators in patients with liver disease: Systematic review with meta-analysis. World J Gastroenterol. 2017;23:5004-17.

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