Alcoholic Liver Disease Clinical Trial
Official title:
Beneficial Effect of Angiotensin-blocking Agent Candesartan on Alcoholic Liver Fibrosis: A Randomized Controlled Trial
Background:
Alcohol is one of principal causes of hepatic fibrosis. Although the most effective
treatment for alcoholic hepatic fibrosis is abstinence of alcohol consumption, additive
treatment to reduce the accumulation of scar tissue can accelerate the improvement of
hepatic fibrosis in alcoholic liver disease. The renin-angiotensin system can be an
attractive antifibrotic target in liver. Several lines of evidence indicate that
overproduction of angiotensin II(ANG II) in chronic liver injury stimulates the activation
of hepatic stellate cells(HSCs) attributed to fibrogenesis. Additionally, the antifibrotic
effect of ANG II blocking agent has been shown in various animal models and hepatitis C
patients. Hence, drugs that inhibit the renin-angiotensin system have promise in
ameliorating hepatic fibrosis in chronic liver injury. However, no study has been conducted
in patients with alcoholic liver disease to evaluate the effect ANG II type I receptor
blocking agent on hepatic fibrosis.
Aim:
This study aimed to investigate the safety and the efficacy of chronic administration of
candesartan to hepatic fibrosis patients with alcoholic liver disease.
Methods
1) Patients with liver fibrosis(F2) were randomized to receive either the angiotensin
receptor blocker(ARB), candesartan(8 mg/day) with ursodeoxycholic acid(UDCA)(600 mg/day)(n =
42), or UDCA alone(n = 43) as control for 6 months. 2)All enrolled patients underwent liver
biopsies twice for measurement of fibrosis score, area of fibrosis and alpha-smooth muscle
actin(SMA) positive and hydroxyproline. 3) Transforming growth factor-beta1(TGF-beta1),
collagen-1, angiotensin II type I receptor(AT1-R), tissue inhibitor of
metalloproteinase-1(TIMP-1), Rac1 and p22phox which represent oxidant stress were also
measured by real-time RT-PCR before and after 6 months of therapy.
n/a
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
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