Alvares-da-Silva MR, de Araujo A, Vicenzi JR, da Silva GV, Oliveira FB, Schacher F, Oliboni L, Magnus A, Kruel LP, Prieb R, Fernandes LNT. Oral l-ornithine-l-aspartate in minimal hepatic encephalopathy: A randomized, double-blind, placebo-controlled trial.
Hepatol Res 2014;
44:956-63. [PMID:
24033861 DOI:
10.1111/hepr.12235]
[Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 12/13/2022]
Abstract
AIM
Evaluate efficacy/safety of oral l-ornithine-l-aspartate (LOLA) in controlling minimal hepatic encephalopathy (MHE).
METHODS
Consecutive cirrhotic outpatients with MHE (defined by psychometric number connection tests A/B [NCT-A/B] and digit symbol substitution test [DSST] score of >2 standard deviations) were randomized to a 60-day oral LOLA (5 g t.i.d) or placebo group. Critical flicker frequency test (CFF), quantitative electroencephalogram (qEEG), arterial ammonia (NH3), Beck's anxiety-depression forms and liver disease quality of life (LD-QOL) were assessed. Patients were followed for 6 months after the end of the study to assess LOLA prophylactic role on overt hepatic encephalopathy (OHE).
RESULTS
Sixty-four patients were included, 63 (98.4%) with MHE. In six of these patients, CFT was less than 39 Hz (9.52%); NH3 was increased in 32 (50.8%); 25% had abnormal qEEG. Age, sex, scholarship, Child-Pugh (CP), Model for End-Stage Liver Disease, NCT-A/B, DSST, CFF and NH3 were similar in both groups at the baseline. LOLA led to a significant improvement in NCT-B age-controlled z-score (3.4 ± 3.4 vs 1.5 ± 2.3, P = 0.01) and CFF (42.2 ± 5.8 vs 45.2 ± 5.8, P = 0.02), comparing the first and the last visit, but there were no differences between LOLA and placebo regarding the whole psychometric battery, CFF, LD-QOL and Beck's forms. No serious adverse effects occurred. Patients taking LOLA had less episodes of OHE at 6 months (5% vs 37.9%, P = 0.016), as they have significant improvement on liver function assessed by CP (P < 0.001).
CONCLUSION
A 60-day oral LOLA course was not better than placebo in treating MHE, but was useful in preventing further episodes of OHE.
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