A randomized controlled trial of high-dose ursodesoxycholic acid for nonalcoholic steatohepatitis.

BACKGROUND & AIMS: Nonalcoholic steatohepatitis (NASH) is a prevalent liver disease associated with increased morbidity and mortality. Ursodeoxycholic acid (UDCA) may have antioxidant, anti-inflammatory, and antifibrotic properties and may reduce liver injury in NASH. To date, no studies have assessed the efficacy and safety of high-dose UDCA (HD-UDCA) in patients with NASH. METHODS: We conducted a 12-month, randomized, double-blind, placebo-controlled multicenter trial to evaluate the efficacy and safety of HD-UDCA (28-35 mg/kg per day) in 126 patients with biopsy-proven NASH and elevated alanine aminotransferase (ALT) levels. The primary study end point was reduction in ALT levels from baseline in patients treated with HD-UDCA compared with placebo. Secondary study end points were the proportion of patients with ALT normalization, relative reduction in the scores of serum markers of fibrosis and hepatic inflammation, and safety and tolerability. RESULTS: HD-UDCA significantly reduced mean ALT levels -28.3% from baseline after 12 months compared with -1.6% with placebo (p<0.001). At the end of the trial, ALT levels normalized (≤35 IU/L) in 24.5% of patients treated with HD-UDCA and in 4.8% of patients who received placebo (p=0.003). Both results were not accounted for by changes in weight during the trial. HD-UDCA significantly reduced the FibroTest® serum fibrosis marker (p<0.001) compared with placebo. HD-UDCA also significantly improved markers of glycemic control and insulin resistance. There were no safety issues in this population. CONCLUSIONS: Treatment with HD-UDCA was safe, improved aminotransferase levels, serum fibrosis markers, and selected metabolic parameters. Studies with histologic end points are warranted.

Efficacy and Safety of a New Formulation of Pancrelipase (Ultrase MT20) in the Treatment of Malabsorption in Exocrine Pancreatic Insufficiency in Cystic Fibrosis.

Background. Pancreatic enzyme replacement therapy is the standard of care for treatment of malabsorption in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (PI). Aim. To evaluate efficacy and safety of a new formulation of pancrelipase (Ultrase MT20) in patients with CF and PI. Coefficients of fat absorption (CFA%) and nitrogen absorption (CNA%) were the main efficacy parameters. Safety was evaluated by monitoring laboratory analyses, adverse events (AEs), and overall signs and symptoms. Methods. Patients (n = 31) were randomized in a crossover design comparing this pancrelipase with placebo during 2 inpatient evaluation periods (6-7 days each). Fat and protein/nitrogen ingestion and excretion were measured from food diaries and 72-hour stool collections. CFA% and CNA% were calculated for each period and compared. Results. Twenty-four patients provided analyzable data. This pancrelipase increased mean CFA% and CNA% (+34.7% and +25.7%, resp., P < .0001 for both), reduced stool frequency, and improved stool consistency compared with placebo. Placebo-treated patients reported more AEs, with gastrointestinal symptoms being the most frequently reported AE. Conclusions. This pancrelipase is a safe and effective treatment for malabsorption associated with exocrine PI in patients with CF.

Lack of effect of sex and disease state on the pharmacokinetics of porfimer sodium.

BACKGROUND: Porfimer sodium is an agent used for photodynamic therapy (PDT) of cancer and other pre-malignant conditions such as high grade dysplasia in Barrett's oesophagus. Since it is activated by non-thermal red light after a 2-day time interval to allow distribution in the target tissues, its pharmacokinetic properties are relevant to the timing of light treatment and to the period of protection against photosensitivity reactions. With the recent availability of a reliable assay overcoming the limitations of previous assays, two definitive pharmacokinetic studies were undertaken. OBJECTIVE: To determine if sex or a target disease state (cancer) have an effect on porfimer sodium pharmacokinetic parameters. METHODS: Twenty-four healthy volunteers (12 men and 12 women) and five male patients with oesophageal cancer undergoing palliative PDT for their obstructive lesions were enrolled. All received an intravenous injection of porfimer sodium (Photofrin) 2 mg/kg over 3-5 minutes and underwent serial blood samplings over 35 days postdose. Porfimer sodium was quantified in serum by a validated spectrofluorometry assay and low-level pre-existing interference was subtracted from postdose concentrations. RESULTS: The two sexes had comparable maximum serum concentrations with a ratio of 0.95. Women tended to have higher areas under the serum concentration-time curve from time zero to the last sampling time, and from time zero to infinity than men, but the difference did not reach significance (ratios of means of 1.18 and 1.20, respectively). Elimination parameters also showed no sex-related differences with a mean distribution half-life of 9.5 hours, clearance of 0.88 mL/h/kg and a terminal elimination half-life of 415 hours (17.3 days). The sexes only differed significantly for the time to reach maximum serum concentration (means of 1.54 and 0.165 hours, for women and men, respectively; p = 0.0239). This is probably because of the sparse sampling schedule and the plateau behaviour of the initial concentrations. The pharmacokinetic parameters in cancer patients were generally comparable to healthy volunteers. However, the mean terminal elimination half-life was 30% shorter (283 hours or 11.8 days) in cancer patients. CONCLUSION: Sex does not have an effect on porfimer sodium pharmacokinetics. The presence of advanced oesophageal cancer does not seem to have any influence either. These findings confirm that there is no need for sex-specific label recommendations. Also, the elimination phase of porfimer sodium starting progressively from 24 hours postdose supports the recommended time interval for laser light application, the window for PDT debridement and the skin protection period of at least 30 days.