The dramatic effect of intravenous glycyrrhizin on acute‐on‐chronic hepatic failure in chronic hepatitis B patients without liver cirrhosis

Abstract

Chronic hepatitis B with acute exacerbation carries a high risk of mortality even in the era of advanced antiviral agents. Derived from Glycyrrhiza glabra roots, glycyrrhizin is a natural compound possessing anti‐inflammatory and antioxidant properties and having a membrane‐stabilizing effect. The significant reductive effect of its aqueous solution, Stronger Neo‐Minophagen C (SNMC), on serum levels of transaminases has been previously demonstrated. Furthermore, it is effective in the treatment of subacute hepatic failure. In this prospective case series, we examined the efficacy of the combination treatment of glycyrrhizin and entecavir on acute‐on‐chronic hepatic failure in chronic hepatitis B patients. Every patient received a combination of oral entecavir and intravenous SNMC 100 mL (glycyrrhizin 200 mg) daily for 5 days. We evaluate the 3‐ and 6‐month survival rates, percentage of patients returning to liver compensation within 30 days, and the days of hospital stay. Ten patients were enrolled in this study. Before treatment, the mean alanine aminotransferase (ALT) and total bilirubin levels were 2101 ± 931 IU/L and 7.4 ± 2.2 mg/dL, respectively. The ALT level nearly halved after 2 days of treatment. The average hospital stay was 6.3 ± 1.3 days, and the 3‐ and 6‐month survival rate was 100%. A return to liver compensation within 30 days was achieved in eight patients (80%). This preliminary study demonstrates the safety and efficacy of combination treatment of SNMC and entecavir for about 5 days, which may result in shorter hospital stays and good survival of chronic hepatitis B patients with acute‐on‐chronic hepatic failure.