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Randomized Controlled Trial
. 2013 Apr 15;168(5):771-8.
doi: 10.1530/EJE-12-0969. Print 2013 May.

Cholic acid for hepatic steatosis in patients with lipodystrophy: a randomized, controlled trial

Zahid Ahmad  1 , Lalitha Subramanyam, Lidia Szczepaniak, Vinaya Simha, Beverley Adams-Huet, Abhimanyu Garg
Affiliations
Randomized Controlled Trial

Cholic acid for hepatic steatosis in patients with lipodystrophy: a randomized, controlled trial

Zahid Ahmad et al. Eur J Endocrinol. .

Abstract

Objective: Hepatic steatosis is a common complication in patients with lipodystrophies and can lead to cirrhosis. There is no proven effective therapy for hepatic steatosis, but cholic acid (CA), a farnesoid X receptor agonist, has previously been shown to reduce hepatic triglyceride (TG) content in mice and serum TG in humans. Our objective was to assess clinical efficacy and tolerability of CA therapy in patients with lipodystrophy and hepatic steatosis.

Design: A randomized, double-blind, placebo-controlled, crossover study.

Methods: Eighteen patients with genetic or autoimmune lipodystrophies and elevated hepatic TG content participated in the study. The intervention was CA (15 mg/kg per day) compared with placebo for a period of 6 months each. Hepatic TG content, the primary outcome variable, was measured with (1)H magnetic resonance spectroscopy at baseline and at 3 and 6 months during each study period. Levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), and TG were secondary end points of the study.

Results: Compared with placebo, CA did not reduce (median (interquartile range) hepatic TG content (14.8% (9.4-19.0%) vs 15.9% (10.5-26.5%) respectively; P=0.42) or serum TG ((340 mg/dl (233-433 mg/dl) vs 390 mg/dl (233-595 mg/dl) respectively; P=0.45)). CA therapy also did not change AST, ALT, or GGT levels. Two patients developed diarrhea and excessive flatus while taking CA and these symptoms resolved after reducing the dose of CA.

Conclusion: CA was well tolerated but did not reduce hepatic TG content in patients with lipodystrophy.

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Conflict of interest statement

Declaration of Interest: The authors have nothing to disclose.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2. CONSORT 2010 Flow Diagram
Figure 3
Figure 3
Hepatic triglyceride content (A) and serum triglyceride levels (B) during the study. Connected open circles represent the 12 subjects who completed both the six month study periods. For three subjects with incomplete data, filled symbols represent subjects with placebo data only; inverted triangles represent 3 month data. Median values for each phase are shown as horizontal bars
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