Actigall (Ursodeoxycholic Acid)

Recently Puoti et al. reported that the bile acid ursodeoxycholic acid (UDCA or ursodiol, Actigall/Summit Pharmaceuticals) may improve serum liver enzyme concentrations in chronic HCV infection. The investigators studied 91 patients (47 males and 44 females) with immunologic, histologic, biochemical, and clinical evidence of chronic HCV liver disease. Serum alanine- aminotransferase (ALT) and gamma- glutamyltransferase (GGT) levels were at least twice the upper limit of normal on three different occasions over the previous 12 months. Patients were not positive for HIV or Hepatitis B, and had not taken interferon. They were randomly assigned to receive UDCA 450 mg at bedtime for 6 months (44 patients) or to no treatment (47 patients). No relevant side effects were reported. Compared with the control group, the UDCA group demonstrated significant decreases in liver enzyme concentrations (reductions of 36.7% for ALT and 47.6% for GGT). It is not known how UDCA decreases enzymes in patients with chronic HCV hepatitis, nor whether this decrease improves liver histology. The authors ask, “Might UDCA be a possible alternative for patients who do not respond to interferon or who relapse after discontinuation of interferon?” Perhaps investigating UDCA will yield insights into the nature of chronic HCV infection. (Puoti C et al. Lancet. 1993; 341 :1413 -1414.)