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Reuters Health Information (2013-03-19): Phlebotomy might help in fatty liver disease

Drug & Device Development

Phlebotomy might help in fatty liver disease

Last Updated: 2013-03-19 13:40:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Iron depletion by phlebotomy might help patients with non-alcoholic fatty liver disease (NAFLD) and high serum ferritin levels, a phase II study suggests.

Later on, if a randomized trial confirms that iron reduction does indeed improve NAFLD in patients with high iron levels, "it would mean that we now have a safe and easily available treatment for this condition," Dr. Melanie D. Beaton told Reuters Health by email.

Hyperferritinemia is common in metabolic syndrome and NAFLD, Dr. Beaton and her colleagues note in a report of their study, published online February 26th in Alimentary Pharmacology and Therapeutics. All of the authors are from the University of Western Ontario in London.

The team had 31 patients with NAFLD undergo phlebotomy biweekly or month, depending on tolerance and availability, with removal of 500 mL of blood at each session until near-iron depletion. Iron depletion was defined as a serum ferritin level of no more than 50 mcg/L or a decline in hemoglobin to 100 g/L or less.

There were no important adverse events, according to the authors. At six months, they saw significant reductions in NAFLD activity score, but not in individual histological features of lobular inflammation, steatosis, hepatocyte ballooning, or fibrosis score.

In six patients with non-alcoholic steatohepatitis (NASH), however, the steatohepatitis resolved, with no increase in fibrosis. Overall, patients with elevated serum ferritin at baseline showed the greatest benefit from iron reduction.

"On the basis of our results," say the investigators, "we suggest that future studies of iron reduction therapy be focused on those patients with baseline serum ferritin of at least 300 mcg/L and steatohepatitis on liver biopsy to more definitively ascertain the magnitude of benefit in this condition."

Commenting on the findings, Dr. Norbert Stefan of the University of T´┐Żbingen, Germany, who wasn't involved in the study, told Reuters Health by email, "This treatment approach is interesting, as increased body iron levels are thought to induce hepatic inflammation in patients with NAFLD and, thereby, promote fibrosis and more advanced states of liver disease. Unfortunately, the beneficial effects of this study on liver histology are relatively small and so far, these results do not allow us to conclude that phlebotomy may in general be a promising treatment strategy for patients with NAFLD."

"However, and also as the authors point out, it may be worth studying whether phlebotomy may be beneficial predominantly in patients with NAFLD having high serum iron levels and in patients with NASH," Dr. Stefan said.


Aliment Pharmacol Ther 2013.

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