A randomized, controlled, crossover pilot study of losartan for pediatric nonalcoholic fatty liver disease

Miriam B Vos, Ran Jin, Juna V Konomi, Rebecca Cleeton, Jessica Cruz, Saul Karpen, Dellys Soler Rodriguez, Jennifer K Frediani, Courtney McCracken, Jean Welsh, Miriam B Vos, Ran Jin, Juna V Konomi, Rebecca Cleeton, Jessica Cruz, Saul Karpen, Dellys Soler Rodriguez, Jennifer K Frediani, Courtney McCracken, Jean Welsh

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in children, and currently, there are no FDA-approved therapies. Plasminogen activator inhibitor-1 (PAI-1) is elevated in children with NAFLD and associated with increased disease severity. Losartan potassium (losartan) is an angiotensin II receptor blocker (ARB) that reduces PAI-1 production and improves insulin sensitivity that has been proposed as a treatment for pediatric NAFLD but has not previously been tested.

Methods: This was an 8-week randomized, double-blind, placebo-controlled, phase 2a, crossover study (with a 6-week washout between conditions) for safety and preliminary efficacy of losartan 50 mg a day taken orally in 12 normotensive children with biopsy proven nonalcoholic steatohepatitis (NASH).

Results: Twelve children enrolled in the study, and nine completed all visits. No changes in blood pressure or serious adverse events occurred during the study. Trends in improvement in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and homeostatic model assessment insulin resistance (HOMA-IR) were seen with losartan treatment compared to the placebo time-period. More participants decreased ALT on losartan as compared to placebo (89% [8 out 9] vs. 56% [5 out of 9], respectively).

Conclusions: This data provides preliminary evidence that losartan treatment is safe over 8 weeks in children with NAFLD and supports consideration of larger studies to test its efficacy.

Trial registration: URL and trial identification number: https://ichgcp.net/clinical-trials-registry/NCT01913470, NCT01913470.Date registered: August 1, 2013.

Keywords: Children; Fatty liver disease; Insulin resistance; Pilot; Plasminogen activator inhibitor-1; Treatment.

Conflict of interest statement

The study was approved by Emory University Institutional Review Board and by Children’s Healthcare of Atlanta Review Board prior to initiation.Is contained within the IRB approval.Dr. Vos receives grant funding and industry consulting in the area of pediatric NAFLD as follows: Dr. Miriam Vos receives research support from Immuron, Shire, AMRA, Resonance Health, Target PharmaSolutions, NIH and Nutrition Science Initiative (NuSI) and consults for Intercept, Allergan, Aegerion, Shire, Immuron, Target PharmaSolutions. The other authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a–d Concentrations of liver enzymes, PAI-1 and HOMA-IR pre- and post-treatment periods

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