Hepatitis outcome evaluation

A small historical study evaluated the effect of DMPA on six patients with either chronic active viral hepatitis or primary biliary cirrhosis. The study showed that DMPA actually improved transaminase levels and the metabolic ability of the liver. The investigators suggested that the immune-modifying properties of medroxyprogesterone may make the hormone a therapeutic alternative [2]. There were limitations in that this was a very small, non-randomised study, and therefore it is difficult to make specific recommendations based on the outcome. Another study of the metabolic effects of DMPA in women who had used the method for five years or more suggested that there was a significant rise in plasma insulin, alkaline phosphatase and morning cortisol levels in the DMPA users [31]. 

Several strategies to treat alcoholic liver disease have been evaluated. Prednisolone may improve survival in patients with severe alcoholic hepatitis and hepatic encephalopathy. Nutrients such as S-adenosylmethionine and polyunsaturated lecithin have been found to have beneficial effects in nonhuman primates and are undergoing clinical trials. Other medications that have been tested include oxandrolone, propylthiouracil, and colchicine. At present, none of these drugs is approved for use in the U.S. for the treatment of alcoholic liver disease. The current primary treatment for liver failure is transplantation in conjunction with abstinence from ethanol. Long-term outcome studies suggest that patients who are alcohol-dependent have survival rates similar to those of patients with other types of liver disease. Alcoholics with hepatitis C may respond to interferon-2a (see Chapter 52). 

Liver Nimesulide-induced hepatotoxidty can occur, with serious and potentially fatal outcomes. Three cases of liver failure related to nimesulide have been reported 77, 78 ]. In a retrospective analysis from the Irish national liver transplant unit all recipients of a liver transplant for fulminant hepatic failure of unknown cause (1994-2007) were evaluated [79 ]. There were 32 patients with seronegative, non-paracetamol-induced liver failure. Nimesulide had been started within 6 months in six patients and was assessed as probably associated with liver injury in all of these cases. 

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