Report 14 From Dallas

Both Fish Oil and Vitamin E Improve ALT (liver function test) in Study
Jules Levin, NATAP

VITAMIN E OR OMEGA-3 FATTY ACID CONCENTRATE (OMACOR‚) AS SUPPRESSIVE TREATMENT FOR PATIENTS WITH CHRONIC HEPATITIS C. 

John B Gross, Laurie A Czaplewski, David J Brandhagen, Albert J Czaja, John J Poterucha, Terry M Therneau, Mayo Clin, Rochester, MN

For patients with chronic hepatitis C who are not candidates for interferon-based treatment, an alternative might be suppressive treatment with a well-tolerated agent that reduces inflammation and might therefore slow progression of fibrosis. Vitamin E has previously been shown to reduce ALT levels among a small group of patients with chronic hepatitis C. Omega-3 fatty acid (O3FA) concentrate (Omacor‚) has been shown to reduce disease activity in chronic conditions such as arthritis and IBD. AIM: to determine whether short-term treatment with vit E or O3FA reduces serum ALT levels among patients with chronic hepatitis C. 

METHODS: Patients had histological evidence of chronic hepatitis, detectable serum HCV RNA, and ALT at least 2X normal. They had received no antiviral, herbal, or vitamin treatment within 30 days of entry. In random order, they were given vit E 400 IU BID x 12 wk, then O3FA 2 g BID x 12 wk, or vice versa, with 12-wk observation after each. Blood tests were monitored at 0, 2, 4, 8, and 12 wk of treatment, and at 12 wk after treatment. 

RESULTS: 20 patients were enrolled, most having failed interferon; 13 have completed treatment and follow-up on vit E, and 10 on O3FA. On vit E, median ALT was ~60% of baseline, starting at 2 wk; 11 of 13 patients had a reduction in ALT. On O3FA, median ALT gradually declined to ~60% of baseline at 12 wk; 7 of 10 had reduced ALT. Median ALT relapsed toward baseline after each treatment. Median ALT (% of baseline): see table. Among 7 patients on vit E with paired PCR results available thus far (Chiron bDNA assay), we found no significant changes in RNA levels on treatment compared to baseline. 

CONCLUSIONS: 1) Both vitamin E and O3FA (Omacor‚) can reduce ALT levels among patients with chronic hepatitis C. 2) The progressive decline in ALT over 12 weeks on O3FA suggests that longer treatment might be beneficial. 3) These agents warrant further study as alternative suppressive treatments for patients who are not candidates for conventional therapy. Grant support was received from Mayo Foundation and from Pronova a.s. (Norway)