Biochemical and Histological Effects of Glycyrrhizin in Patients with Chronic Hepatitis C

Given the side effects and suboptimal response to interferon-based treatment, there has been considerable interest in alternative and complementary therapies for patients with chronic hepatitis C.

Among the most promising herbal therapies is glycyrrhizin, an active component of licorice root (Glychyrrhiza glabra), which has long been used in Chinese medicine to treat liver diseases.

Previous Phase I/II studies showed that 4 weeks treatment with glycyrrhizin lowered alanine aminotransferase (ALT) levels in Western patients with chronic hepatitis C.

As reported in the October 2006 Journal of Hepatology, researchers from the Netherlands conducted a study to determine the dose frequency of glycyrrhizin needed to maintain this biochemical response beyond 4 weeks, and to evaluate the herb's effects on liver histology and quality of life.

The current study included hepatitis C patients with elevated ALT and marked fibrosis or necroinflammation who were not eligible for interferon-based therapy. Participants were treated for 4 weeks with 6 weekly infusions of glycyrrhizin. Patients with an ALT response at week 4 were randomly assigned to continue treatment for 22 weeks in one of 3 dose frequency groups, receiving glycyrrhizin either 6 times, 3 times, or once weekly.

Results

72 out of 121 patients (60%) were randomized to continued therapy.

At the end of treatment, the rates of continued ALT response were:

- 60% in the 6 times weekly arm;
- 24% in the 3 times weekly group;
- 9% in the once weekly group (P < 0.001).

In ALT responders, the necroinflammation score improved compared with ALT non-responders, but the difference was not statistically significant.

Quality of life, as assessed by the SF-36 questionnaire, improved in patients treated with glycyrrhizin, but this was not related to ALT response.

Conclusion

The authors concluded that, "ALT responses induced by 4 weeks glycyrrhizin therapy can be maintained in a subset of chronic hepatitis C patients receiving at least 3 injections weekly." However, they added, "The observed ALT response was not reflected in a significant histological improvement after 6 months treatment."

9/12/06

Reference
H Orlent, B E Hansen, M Willems, and others. Biochemical and histological effects of 26 weeks of glycyrrhizin treatment in chronic hepatitis C: a randomized phase II trial. Journal of Hepatology 45(4): 539-546. October 2006.