A randomised controlled trial of losartan as an anti-fibrotic agent in non-alcoholic steatohepatitis

作者：McPherson Stuart^*; Wilkinson Nina; Tiniakos Dina; Wilkinson Jennifer; Burt Alastair D; McColl Elaine; Stocken Deborah D; Steen Nick; Barnes Jane; Goudie Nicola; Stewart Stephen; Bury Yvonne; Mann Derek; Anstee Quentin M; Day Christopher P

来源：PLos One, 2017, 12(4): e0175717.

DOI：10.1371/journal.pone.0175717

Introduction
Non-alcoholic fatty liver disease (NAFLD) is a common liver disease worldwide. Experimental and small clinical trials have demonstrated that angiotensin II blockers (ARB) may be anti-fibrotic in the liver. The aim of this randomised controlled trial was to assess whether treatment with Losartan for 96 weeks slowed, halted or reversed the progression of fibrosis in patients with non-alcoholic steatohepatitis (NASH).
Methods
Double-blind randomised-controlled trial of Losartan 50 mg once a day versus placebo for 96 weeks in patients with histological evidence of NASH. The primary outcome for the study was change in histological fibrosis stage from pre-treatment to end-of-treatment.
Results
The study planned to recruit 214 patients. However, recruitment was slower than expected, and after 45 patients were randomised (median age 55; 56% male; 60% diabetic; median fibrosis stage 2), enrolment was suspended. Thirty-two patients (15 losartan and 17 placebo) completed follow up period: one patient (6.7%) treated with losartan and 4 patients (23.5%) in the placebo group were '' responders '' (lower fibrosis stage at follow up compared with baseline). The major reason for slow recruitment was that 39% of potentially eligible patients were already taking an ARB or angiotensin converting enzyme inhibitor (ACEI), and 15% were taking other prohibited medications.
Conclusions
Due to the widespread use of ACEI and ARB in patients with NASH this trial failed to recruit sufficient patients to determine whether losartan has anti-fibrotic effects in the liver.

• 出版日期2017-4-18