A Multicenter and Randomized Controlled Trial of Bicyclol in the Treatment of Statin-Induced Liver Injury

Wu Naiqiong, Wang Liansheng, Han Zhanying, Guo Yuanlin, Zhu Chenggang, Gao Ying, Dong Qian, Liu Dongchen, Zhou Yanjun, Li Jianjun, Wu Naiqiong, Wang Liansheng, Han Zhanying, Guo Yuanlin, Zhu Chenggang, Gao Ying, Dong Qian, Liu Dongchen, Zhou Yanjun, Li Jianjun

Abstract

BACKGROUND The aim of this study was to evaluate the efficacy and safety of bicyclol treatment in statin-induced liver injury. MATERIAL AND METHODS The study included 168 patients with liver injury caused by statins. Patients were randomized into two four-week treatment groups: bicyclol 25 mg three times daily or polyene phosphatidylcholine 456 mg three times daily as control. Serum biochemical indexes were compared before and after treatment. RESULTS Significant differences in alanine transaminase (ALT) levels among the three measurements before and after treatment in the two groups at different time points were observed (p<0.01). There was a significant difference (p<0.01) between two weeks and four weeks after treatment compared to the baseline period. There was a significant interaction (p=0.003) between the two groups and time factors. After two and four weeks of treatment, the ALT levels in the control group (68.20±26.31, 50.71±27.13 respectively) were higher compared to the ALT in the bicyclol group (49.33±21.39, 30.36±17.41 respectively) (p<0.01). After four weeks of treatment, the normalization rates of bicyclol and polyene phosphatidylcholine groups were 74.68% and 46.15%, respectively. The efficacy of bicyclol was significantly better than that of polyene phosphatidylcholine (p<0.05). The incidence of adverse reactions in the bicyclol and polyene phosphatidylcholine groups were 2.53% and 2.56%, respectively, with no statistically significant differences observed between the two groups (p>0.05). CONCLUSIONS These findings suggest that trends of ALT changes in the two groups were different, and the improvement of ALT was more obvious in the bicyclol group. Bicyclol is considered to be safe and effective in the treatment of statin-induced liver injury.

Figures

Figure 1
Figure 1
Flow diagram of the studies inclusion.
Figure 2
Figure 2
ALT changes in two groups.

References

    1. Cholesterol Treatment Trialists (CTT) Collaboration. Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.
    1. Hu M, Cheung BM, Tomlinson B. Safety of statins: An update. Ther Adv Drug Saf. 2012;3(3):133–44.
    1. Kwon H, Lee SH, Kim SE, et al. Spontaneously reported hepatic adverse drug events in Korea: Multicenter study. J Korean Med Sci. 2012;27:268–73.
    1. Kashani A, Phillips CO, Foody JAM, et al. Risks associated with statin therapy. Circulation. 2006;114:2788–97.
    1. Jacobson TA. NLA Task Force on statin safety – 2014 update. J Clin Lipidol. 2014;8:S1–S4.
    1. Working Group of the Evaluation on the Safety of Statins. [Experts consensus of the evaluation on the statin drugs safty]. Chinese Journal of Cardiology. 2014;42(11):890–94. [in Chinese]
    1. Wang Z, Ge J. Managing hypercholesterolemia and preventing cardiovascular events in elderly and younger Chinese adults: Focus on rosuvastatin. Clin Interv Aging. 2014;9:1–8.
    1. Chinese Adult Dyslipidemia Prevention and Treatment Guidelines Development Joint Committee. [Chinese adult dyslipidemia prevention and treatment guidelines]. Chinese Journal of Cardiology. 2007;35(5):390–413. [in Chinese]
    1. Yu YC, Mao YM, Chen CW, et al. CSH guidelines for the diagnosis and treatment of drug-induced liver injury. Hepatol Int. 2017;11(3):221–41.
    1. Liu G-T. Bicyclol: A novel drug for treating chronic viral hepatitis B and C. Med Chem. 2009;5(1):29–43.
    1. Xie W, Shi G, Zhang H, et al. A randomized, multi-central, controlled study of patients with hepatitis B e antigen-positive chronic hepatitis B treated by adefovir dipivoxil or adefovir plus bicyclol. Hepatol Int. 2012;6:441–48.
    1. Chu NH, Li L, Zhang X, et al. Role of bicyclol in preventing drug-induced liver injury in tuberculosis patients with liver disease. Int J Tuberc Lung Dis. 2015;19(4):475–80.
    1. Danan G, Benichou C. Causality assessment of adverse reactions to drugs – I. A novel method based on the conclusions of international consensus meetings: Application to drug-induced liver injuries. J Clin Epidemiol. 1993;46(11):1323–30.
    1. Suk KT, Kim DJ. Drug-induced liver injury: Present and future. Clin Mol Hepatol. 2012;18(3):249–57.
    1. Li L, Jiang W, Wang J. Clinical analysis of 275 cases of acute drug-induced liver disease. Front Med China. 2007;1(1):58–61.
    1. Lai RT, Wang H, Gui HL, et al. Clinical and pathological features in 138 cases of drug-induced liver injury. Chin J Hepatol. 2012;20(3):185–89.
    1. HaD KY, Yu YC, He CL, et al. RUCAM scale-based diagnosis, clinical features and prognosis of 140 cases of drug-induced liver injury. Chin J Hepatol. 2014;22(12):82–85.
    1. Russmann S, Jetter A, Kullak-Ublick GA. Phamacogenetics of drug-induced liver injury. Hepatology. 2010;52(2):748–61.
    1. Zou J, Qi F, Ye L, et al. Protective role of grape seed proanthocyanidins against Ccl4 induced acute liver injury in mice. Med Sci Monit. 2016;22:880–89.
    1. Tan J, Yang N, Fu X, et al. Single-dose local simvastatin injection improves implant fixation via increased angiogenesis and bone formation in an ovariectomized rat model. Med Sci Monit. 2015;21:1428–39.
    1. Jose J. Statins and its hepatic effects: Newer data, implications, and changing recommendations. J Pharm Bioallied Sci. 2016;8(1):23–28.
    1. Calderon RM, Cubeddu LX, Goldberg RB, et al. Statins in the treatment of dyslipidemia in the presence of elevated liver aminotransferase levels: A therapeutic dilemma. Mayo Clin Proc. 2010;85(4):349–56.
    1. Tajiri K, Shimizu Y. Practical guidelines for diagnosis and early management of drug-induced liver injury. World J Gastroenterol. 2008;14(44):6774–85.
    1. Bjornsson E, Jacobsen EI, Kalaitzakis E. Hepatotoxicity associated with statins: Reports of idiosyncratic liver injury post-marketing. J Hepatol. 2012;56:374–80.
    1. Kubota T, Fujisaki K, Itoh Y, et al. Apoptotic injury in cultured human hepatocytes induced by HMG-CoA reductase inhibitors. Biochem Pharmacol. 2004;67(12):2175–86.
    1. Xiaowei Y. [Liver safety of statins]. Chinese Journal of Cardiology. 2011;39(3):201–2. [in Chinese]
    1. Mei L, Lun-Gen L, Min-De Z. Study progress in protective mechanism of polyene phosphatidylcholine on hepatocytes. Liver. 2006;11(1):43–45.
    1. Liu GT, Li Y, Wei HL, et al. Mechanism of protective action of bicyclol against CCl4-induced liver injury in mice. Liver Int. 2005;25:872–79.
    1. Wang H, Li Y. Protective effect of bicyclol on acute hepatic failure induced by lipopolysaccharide and D-galactosamine in mice. Eur J Pharmacol. 2006;534:194–201.
    1. Yan W, Jinping H. Effects of bicyclol on plasma pharmacokinetics of tacrolimus and atorvastatin after oral administration in rats. Liver. 2016;21(11):969–72.
    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of American college of cardiology/American heart association task force on practice guidelines. Circulation. 2014;129(25 Suppl 2):S1–45.

Source: PubMed

3
Subscribe