Background
While no “gold-standard” pharmacotherapy for nonalcoholic fatty liver disease (NAFLD) is yet established, essential phospholipids (EPLs) are reported to decrease steatosis and improve ...laboratory parameters.
Objective
This analysis evaluated adherence and satisfaction with EPL treatment as patient-reported outcomes and their relationship with changes in laboratory and ultrasound parameters among Russian patients with NAFLD.
Methods
Data were pooled from three observational Russian studies—MANPOWER (2015–2016), LIDER 1 (2012–2013), and LIDER 2 (2013)—in which EPLs were used for at least 12 weeks in the treatment of liver diseases and which measured both subjective and objective endpoints. Only patients who had NAFLD were included in this analysis. The main endpoints were to determine treatment adherence and satisfaction with 12 weeks of EPL therapy, relationship between adherence/satisfaction and changes in the laboratory and ultrasound parameters. A secondary subgroup analysis was performed to identify patients with NAFLD who responded better (or worse) to 24 weeks of adjunctive EPL treatment.
Results
Overall, 3384 patients were included. A total of 82.2% of patients were adherent to 12 weeks of EPL treatment; high/very high satisfaction was reported by 15.3%/65.9% of clinicians and 15.9%/64.4% of patients. There was positive correlation between patients’ adherence and satisfaction and significant improvement in laboratory (transaminases, lipid profile;
p
< 0.001) and ultrasound (steatosis,
p
< 0.001) parameters, and improvement in symptoms (
p
< 0.001) after 24 weeks of EPL. Male patients, patients with unhealthy lifestyles, and those with more comorbidities showed a better response in laboratory and ultrasound parameters.
Conclusions
Patients with NAFLD treated with adjunctive EPL therapy in real-world clinical practice in Russia showed good treatment adherence and treatment satisfaction. Improvements in laboratory and ultrasound parameters, as well as dynamics of patient symptoms, were positively correlated with adherence and satisfaction.
Plain Language Summary
Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease, and patients have a risk of liver cancer and needing transplantation. Patients with advanced NAFLD are usually recommended to use medication. Clinical trials in patients with NAFLD showed that essential phospholipids (EPLs) comprising phosphatidylcholine improved liver fat accumulation (known as steatosis), so treatment guidelines in several countries recommend they be added to the usual therapy. EPLs have been associated with both objective and subjective improvements. This real-world study evaluated three observational studies to assess how patient adherence and satisfaction with EPL treatment were related to changes in clinical parameters in 3384 Russian patients with NAFLD. Overall, 82.2% of patients were adherent with 12 weeks of EPL therapy, and almost two-thirds of patients (64.4%) and clinicians (65.9%) reported very high satisfaction with treatment. Patients’ adherence and satisfaction increased alongside significant improvements in liver enzymes, lipid levels, liver fat content (steatosis), and fewer symptoms after 24 weeks of EPL therapy. Male patients, those with an unhealthy lifestyle, and those with other comorbid conditions had the best response to EPL therapy. This study shows that Russian patients with NAFLD have good adherence and satisfaction with EPL therapy in routine clinical practice and highlights the importance of adherence to EPL therapy in these patients.
Lysosomal acid lipase deficiency (LALD) is a rare genetic disease characterized by the accumulation of cholesteryl esters and triglycerides in many organs, including the liver, spleen, lymph nodes, ...bone marrow, and vascular endothelium. Patients with LALD can appear asymptomatic until liver failure or premature sudden death from coronary artery disease, stroke, and aneurysm, which lead to the diagnosis. Herein, we present a diagnostic workup in a young 17-year-old female patient who manifested hepatosplenomegaly, elevated liver enzymes, severe dyslipidemia, and systemic atherosclerosis. Liver biopsy demonstrated over 90% diffuse microvesicular steatosis, lipid accumulation in Kupffer cells, and birefringent cholesteryl ester crystals. The diagnosis of LALD was proven by the decrease of lysosomal acid lipase activity in dried blood spots and by the detection of two compound heterozygous mutations in the LIPA gene: nonsense mutation G796T (Gly266Term) and splicing site mutation G894A (E8SJM). The patient started enzyme replacement therapy with sebelipase alfa. Following the 1-year treatment, the patient remained asymptomatic, her serum aminotransferase levels were normal, liver density increased due to lipid resorption, and plaque-associated stenosis of carotid artery regressed. Moreover, liver biopsy showed a decrease of cholesteryl ester crystals in Kupffer cells.
An estimated 336 per 100 000 people in Russia are infected with hepatitis C virus, including up to 75% with genotype (GT) 1b. In the TURQUOISE-II/-III trials, a 12-week regimen of the direct-acting ...antiviral agents ombitasvir (OBV), paritaprevir (PTV), ritonavir, and dasabuvir (DSV) in GT1b-infected patients with compensated cirrhosis resulted in 12-week sustained virologic response (SVR) rates of 100%.
In TURQUOISE-IV, GT1b-infected patients (n=36) from Russia and Belarus with compensated cirrhosis, who were treatment naive or previously treated with pegylated interferon/ribavirin (RBV), received OBV/PTV/ritonavir+DSV+RBV for 12 weeks. The primary efficacy end point was SVR at 12 weeks. Safety assessments included adverse event (AE) monitoring and laboratory testing.
At baseline, patients had Child-Pugh scores of 5 (92%) or 6 (8%). Overall, 69% were treatment experienced (44% prior null responders, 32% relapsers, and 16% partial responders). All patients achieved SVR at 12 weeks (36/36; 100%). No patient experienced a serious AE or discontinued treatment prematurely. Treatment-emergent AEs possibly related to study drugs occurring in greater than or equal to 10% of patients were asthenia (19%), anemia (14%), cough (14%), and headache (11%); most events were mild in severity. Clinically significant laboratory abnormalities were infrequent.
In Russian and Belarusian patients with hepatitis C GT1b infection and compensated cirrhosis, 100% achieved SVR at 12 weeks after 12 weeks' treatment with OBV/PTV/ritonavir+DSV+RBV. The treatment was well tolerated.
Background: Second-generation thrombopoietin receptor agonists (TPO-RAs) are emerging as the new standard for managing thrombocytopenia (TCP) in patients with chronic liver diseases (CLDs) undergoing ...scheduled procedures. However, practical guidance for their routine use in CLD patients undergoing specific invasive procedures is lacking. Methods: These practice guidelines were developed by the Initiative Group for Central European Hepatologic Collaboration (CEHC), composed of nine hepatologist/gastroenterologist experts from Central Europe. Using an adapted Delphi process, the CEHC group selected ten invasive procedures most relevant to the hepatology/gastroenterology setting in the region. Consensus recommendations for each invasive procedure are reported as a final percentage of expert panel responses. Results: A consensus was agreed that TPO-RAs should be considered for raising platelet count in CLD patients undergoing scheduled abdominal surgery, high-bleeding risk dentistry, endoscopic polypectomy, endoscopic variceal ligation, liver biopsy, liver surgery, liver transplantation and percutaneous ablation, but it was also agreed that they are less beneficial or not necessary for endoscopy without intervention and paracentesis. Conclusions: Using a modified Delphi method, experts reached an agreement for TCP management in CLD patients undergoing ten invasive procedures. These practice guidelines may help with decision making and patient management in areas where clinical evidence is absent or limited.
Succinate as a mobilization cue Maevsky, Eugene I; Vasilyeva, Anna A; Kozhurin, Mikhail V ...
Cardiometry,
11/2020
17
Journal Article
Peer reviewed
Open access
Succinic acid, being a metabolite of the Krebs cycle and the end product of anaerobic transformations in mitochondria, functions outside mitochondria and cells as a regulatory signal. In the cytosol, ...micromolar amounts of succinate stabilize the transcriptional hypoxia-inducible factor HIF, which triggers the genes responsible for adaptation to hypoxia. Outside the cells, succinate activates the SUCNR1 receptor, which increases the concentration of intracellular calcium. The effect of short bursts of endogenous succinate accumulation and signaling after hypoxia/ischemia, or extreme glucose use from physical exercise should be distinguished from the effect of a permanently increased level of endogenous succinate under pathology (obesity, diabetes mellitus, chronic ischemia, succinate dehydrogenase damage). A short succinate signal triggers an adaptive response by an organism. Prolonged rise and highly elevated levels of endogenous succinate is a pro-inflammatory, damaging factor that can contribute to the progression of neoplasms. Use of succinate-containing compositions at a dose of 0.5-5 millimole can only provide a short signal. This is due to the positive effect of a number of succinate-containing agents.
The article analyzes the promotional activity of outstanding Russian encyclopedist Michail Lomonosov who founded the fundamentals of science in Russia and tried to make scientific knowledge available ...for the wide range of readers in the XVIII century. Also, different forms of dissemination of scientific knowledge that Lomonosov used in the academic and educational activities were examined in the article.
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