A comparison of treatments offered to patients with nonalcoholic steatohepatitis

Objective: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels. Study design: Retrospective cohort study. Place and duration of study: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007. Methodology: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical characteristics of the subjects. The treatment options were categorized as weight reduction alone, with statins, and with other medications. Serum ALT level was the main outcome measured in IU/I. Repeated-measures ANOVA, using a mixed model approach was performed with treatment options as between subject factor, and follow-up as within subject factor and p-value < 0.05 was considered significant. Results: Sixty-nine records of subjects, consisting of 50 males and 19 females were selected. The mean (± SD) age was 40±12 years. Thirty-one subjects (45%) were advised weight reduction only, and experienced a 72% reduction in serum ALT levels, over the mean follow-up time of 9±3 months. Twelve subjects (17%) received statins along with weight reducing advice, and experienced a 56% reduction in mean ALT over the mean follow-up of 11±7 months. Twenty-six subjects (38%) received other medications along with advice for weight reduction and experienced a 73% reduction in serum ALT levels over the mean time of 10±4 months. The mean ALT declined at follow-up times, irrespective of the prescribed treatment, and that the decline with time was different for males and females. Conclusion: Serum ALT levels among patients with NASH decreased with time, regardless of the provided treatment, and the decrease was different for males and females.