The efficacy of hepatoprotective agents in the treatment of non-alcoholic fatty liver disease: metabolic effects and impact on liver fat content

Non-alcoholic fatty liver disease (NAFLD) is a complex interdisciplinary problem due to high distribution of this pathology in the world and its association with cardiometabolic and oncological diseases. The efficacy of NAFLD treatment remains a subject of debate despite much attention is currently being paid to this disease study. Hepatoprotectors play a major role in treatment. Objective. To compare the hepatoprotective effect of fixed combination of inosine, meglumine, methionine, nicotinamide, succinic acid (Remaxol drug), ursodeoxycholic acid (Ursosan drug) and their combination in patients with non-alcoholic fatty liver disease, as well as to evaluate the role of mentioned drugs in reducing the severity of liver steatosis according to the clinical laboratory and visualized examination methods. Material and methods. A prospective open non-randomized study involving 69 patients with NAFLD, mean age was 52.7 years was carried out. All participants were divided into 4 groups depending on the performed therapy. Patients were informed about all options of NAFLD therapy within this study before the treatment, after what they independently selected the group to be included in. Patients in the first group were treated with a combination of Ursosan and Remaxol (n=18), patients in the second group — with Remaxol and Remaxa Pro Aktiv (n=14), patients in the third group — with Ursosan (n=18), patients in the fourth group (comparison group) — non-pharmacological treatment (n=23). Clinical laboratory examination was carried out before and after the treatment: ultrasound investigation and magnetic resonance imaging of the abdominal organs with determination of the liver fat fraction, identification of the levels of alanine aminotransferase, aspartate aminotransferase, blood glucose, uric acid, lipid profile indicators. Statistical data processing was done using Python in the Jupyter Notebook environment. Results. A statistically significant reduction in liver fat fraction, levels of cholesterol, triglycerides, uric acid was noted in presence of drug therapy (Ursosan + Remaxol, Remaxol + Remaxa Pro Aktiv, as well as Ursosan). Conclusion. All treatment regimens were effective in improving metabolic processes as well as in reducing liver fat fraction. The combination of pathogenetically substantiated drug therapy and non-pharmacological methods can be a feasible way to treat non-alcoholic fatty liver disease and associated diseases.