Antioxidant drugs combined with alpha-interferon in chronic hepatitis C not responsive to alpha-interferon alone: a randomized, multicentre study

OBJECTIVE

After non-response to the initial course of therapy, retreatment with alpha-interferon is not effective. The aim of this study was to ascertain whether the administration of N-acetyl cysteine and vitamin E could increase the response rate to retreatment with alpha-interferon.

DESIGN

Prospective, multicentre clinical trial.

SETTING

Twelve hospitals in Lombardy, Italy.

PARTICIPANTS

120 consecutive patients affected by biopsy-proven chronic hepatitis C who had been non-responders to a previous course of alpha-interferon, administered at the dosage of 3-6 million units (MU) three times a week (tiw) for 6 months.

INTERVENTIONS

The patients were randomly assigned to one of two groups of treatment: group A, natural interferon-alphaN3, 6 or 9 MU tiw, when the body weight was < 60 kg or > or = 60 kg, respectively; group B, the same dosage of natural interferon-alphaN3 in association with oral administration of N-acetyl cysteine 1200 mg/day and vitamin E 600 mg/day. The period of treatment was 6 months in both groups.

RESULTS

Neither end-therapy biochemical response nor sustained biochemical response rates were improved by the combination treatment, and in no case was clearance of the virus from serum observed.

CONCLUSIONS

In this randomized study carried out on 120 patients with chronic hepatitis C not responsive to alpha-interferon, oral supplementation with N-acetyl cysteine and vitamin E did not improve the poor efficacy of retreatment with alpha-interferon alone.

Prevalence of GB virus-C/hepatitis G virus infection in patients with cryptogenic chronic liver disease and in patients with primary biliary cirrhosis or Wilson's disease

OBJECTIVE

To assess the role of hepatitis G virus (HGV) in cryptogenic chronic liver disease (CLD), we investigated the prevalence of HGV RNA among patients with cryptogenic CLD, patients with nonviral CLD (primary biliary cirrhosis [PBC] and Wilson's disease [WD]) and subjects without clinically evident liver disease (controls).

METHODS

Ninety patients with cryptogenic CLD (43 with chronic hepatitis, 20 with cirrhosis, and 27 with hepatocellular carcinoma [HCC]), 143 patients with PBC, 22 patients with WD, and 134 controls were recruited. HGV RNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) and antibodies against HGV E2 protein (anti-E2) by an immunoassay test.

RESULTS

HGV RNA was detected in 7.8% of patients with cryptogenic CLD (chronic hepatitis, 9.3%; cirrhosis, 5.0%; HCC, 7.4%), in 2.4% of patients with PBC or WD, and in 2.2% of controls. As a consequence, a positive association of HGV infection with cryptogenic CLD was found (odds ratio, 3.1; 95% confidence interval [CI], 1.0-9.7; p = 0.05). No difference was observed between HGV RNA-positive and -negative patients by age, sex, histology, or liver function tests. Anti-E2 prevalence did not differ between patients with cryptogenic CLD (26.5%), patients with PBC (28.1%), and controls (22.1%). Transfusion history was associated with HGV RNA but not with anti-E2 seropositivity.

CONCLUSIONS

Although an association was found between cryptogenic CLD and HGV infection, the role of the virus seems far from important, the proportion of cryptogenic CLD attributable to it being only 5.2%.

[Azithromycin versus amoxicillin in triple therapy for the treatment of Helicobacter pylori infection]

BACKGROUND

To establish if azithromycin, in association with omeprazole and metronidazole, is effective to eradicate Helicobacter pylori, compared to amoxicillin in triple therapy.

METHODS

Two hundred consecutive patients with duodenal ulcer and Helicobacter pylori infection were enrolled in the study: group a) 100 patients (69 males, 31 females; mean age 47.61 years; range 23-75); group b) 100 patients (70 males, 30 females; mean age 45.56 years; range 22-72). Group a) omeprazole 20 mg od, azithromycin 500 mg od the first three and the last three days of association with metronidazole, this one 250 mg qid, for ten days; group b) omeprazole 20 mg od, amoxicillin 1 g bid, metronidazole 250 mg qid for ten days. Omeprazole was continued for other four weeks in each treatment with the same dosage.

RESULTS

In group a ulcer healing was observed in 89 patients (89 %), while in group b in 93 patients (93%) (p=n.s.). Helicobacter pylori infection was eradicated in group a in 70 patients (70 %), while in group b in 78 patients (78 %) (p=n.s.). Side effects in 11 patients (5.5 %), in particular: group a 5 (5 %), group b 6 (6 %) (p=n.s.).

CONCLUSIONS

Azithromycin could be proposed for treatment of Helicobacter pylori eradication.

Effects of long-term administration of low-dose lactitol in patients with cirrhosis but without overt encephalopathy

To investigate the efficacy and the acceptability of different doses of lactitol in patients with subclinical hepatic encephalopathy, 28 patients with cirrhosis were enrolled in a controlled clinical trial comparing 5-month therapies with lactitol at two different doses: 0.3 and 0.5 g/kg bw per day. This period was followed by 1 month of recovery. Patients were monitored with venous blood ammonia determination, three psychometric tests, clinical evaluation of mental status and EEG. The porto-systemic encephalopathy index of Conn was determined periodically. Twenty-two patients completed the trial (11 for each dose of lactitol). Both doses of lactitol decreased plasma ammonia levels and improved the porto-systemic encephalopathy index. The higher dose was more effective in improving performance in the psychometric tests. After the period of recovery, both the porto-systemic encephalopathy index and the psychometric test scores returned to pretreatment values. Lactitol was tolerated well by patients. Three patients given the higher dose reported periodic intestinal discomfort, but did not stop taking lactitol or reduce the dosage; no side-effects were reported by the patients taking the lower dose. These results indicate that lactitol in doses ranging from 0.3 to 0.5 g/kg bw is a well-tolerated and effective treatment for subclinical encephalopathy.

[Cardiac magnetic resonance with electronic axial angulation]

MR usually provides sections in three standard orthogonal plans (axial, sagittal, coronal). In the present research we have studied the possibilities and the benefit of the anatomical images performed along the main cardiac axis, using--beyond the cardiac gating--a particular software which allows to obtain layers with a double angulation, still keeping the patient supine. This provides a more detailed visualization of the cardiac architecture and a good evaluation of its functional conditions.

Effect of gamma-aminobutyric acid on growth hormone and prolactin secretion in man: influence of pimozide and domperidone

To investigate the possibility that GH release induced by gamma-aminobutyric acid (GABA) in man is mediated by a dopaminergic mechanism(s), we evaluated the effect of two antidopaminergic compounds, pimozide and domperidone, on the plasma GH response to acute GABA administration (5 g, orally). Only the former compound can freely cross the blood-brain barrier. In 9 normal volunteers, GABA caused a significant increase of plasma GH levels (P < 0.0001 vs. GH levels in a group of 14 controls). In these subjects, pimozide (6 mg/day, orally, for 4 days) significantly blunted the GH elevation induced by GABA (P < 0.01). Unlike pimozide, in 8 additional subjects, domperidone (4 mg injected iv immediately before GABA administration) did not influence the GABA-induced GH response. GABA did not alter either baseline or pimozide-stimulated plasma PRL levels. Likewise, it did not significantly modify the brisk PRL rise after domperidone injection. These findings are consistent with the hypothesis that GABA-stimulated GH secretion is mediated via dopamine release at a suprapituitary level. With regard to PRL secretion, no GABA-dopamine interactions are readily apparent.