Ursodeoxycholic pharmacology

Ursodeoxycholic acid was used to treat acute viral hepatitis B without cholestasis for the first time by our working group in 1988. (166) At the time, we attributed the markedly positive effect of treatment in 9 out of 10 patients to the potential immunomodulatory effect of UDCA. (149, 154, 216) In 1993 reports were also published by A. D. Jorge on the good results achieved in 22 patients suffering from acute viral hepatitis and cholestasis. Administration in acute viral hepatitis is therefore recommended in controlled studies, since side effects are not to be expected and the current level of knowledge on the pharmacological effects of UDCA can be deepened. The beneficial effects of UDCA as reported so far in the cholestatic course of acute viral hepatitis are evidence of the success of this treatment. 

If cholestasis is not present, the additional application of ursodeoxycholic acid (UDCA) is worth considering because of its pharmacological properties and lack of side effects or interactions. Initial results on the treatment of chronic hepatitis with UDCA were reported by F. IcHiDA (1961), T. Nakahara et al. (1975) and K. Miyaji (1976). (s. p. 705) In 1988 our study group also noted obvious and permanent effects of UDCA on the course of disease in terms of clinical and laboratory indices in severe acute viral hepatitis B. (s. p. 437) Such observations were confirmed by A. Jorge in 1993. Owing to the multiple mechanisms of action of UDCA, in particular its immunomodulatory effect, adjuvant therapeutic efficacy can be anticipated in autoimmune hepatitis, as reported by P. Janowitz et al. in 1996. In autoimmune-associated chronic hepatitis C, UDCA proved to be a successful therapeutic agent (K. Nakamura et al., 1999). 

Tab. 40.7 Biochemical and pharmacological modes of action of ursodeoxycholic acid...

Tab. 40.8 Demonstrated, empirically confirmed or pharmacologically justified indications for the therapeutic use of ursodeoxycholic acid (with some references)...

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