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Is telmisartan effective in treating non-alcoholic steatohepatitis?
Date:3/3/2009

lin resistance in mild-to-moderate hypertensive patients with histologically confirmed NASH, showing that monotherapy with ARBs on a regularly base can ameliorate cytolysis and NAS, while the secondary endpoint was to prove certain superiority of telmisartan vs valsartan probably linked to its specific insulin sensitizing action releated to the peroxisome proliferator activated receptor (PPAR) gamma - modulatory effects. This is one of the first human blinded trials evaluating the effects of telmisartan and valsartan in steatohepatitis that uses paired liver biopsies with NAS evaluation, simultaneously with cytolysis, insulin resistance, and lipid profile assessment.

The group followed-up the patients for 20 months observing that although serum aminotransferases did not normalized in either group, telmisartan reduced cytolysis by 30.28% and improved insulin resistance by 42.63% consequently with a significant decrease of NAS and fibrosis scores and an amelioration of the lipid profile. Conversely, despite a significant reduction of cytolysis levels by 23.22% and of IR by 21.4%, valsartan did not improved liver histology (except steatosis) and had no effect on plasma lipids. By observing in clinical conditions significant reduction of insulin resistance by both ARBs, as well as a moderate decrease of cytolysis, the study confirms that ARBs not only can correct hypertension, but also can act by preventing and treating steatohepatitis as an end-organ effect of metabolic syndrome. On the other hand, ARBs can prevent collagen synthesis and further progression to cirrhosis. To date, as equally cheap, effective and well-supported antifibrotic therapies are hard to be found, the authors predict that this property will put ARBs in the pole position for treating at least the liver fibrosis.

There are two major advantages that make ARBs a first-class therapeutic option for treating NASH and metabolic syndrome: their specific antihypertensive effect and the im
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Contact: Lai-Fu Li
wjg@wjgnet.com
86-105-908-0039
World Journal of Gastroenterology
Source:Eurekalert

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