DDB treatment of patients with chronic hepatitis

We report 13 patients (10 with chronic hepatitis C, 1 with chronic hepatitis B, 2 with nonalcoholic steatohepatitis) with persistently elevated alanine aminotransferase (ALT) levels who were treated with dimethyl-4,4'-dimethoxy-5,6,5',6-dimethylenedioxybiphenyl-2,2' dicarboxylate (DDB). ALT rapidly normalized in 12/13 patients and remained normal during treatment. Unlike ALT levels, aspartate aminotransferase, gamma-glutamyl transferase and glutamate dehydrogenase levels were not affected. Furthermore, there was no beneficial effect on the histological grade and stage of liver disease. In vitro experiments with hepatocytes resulted in a significant decrease of hepatocellular ALT levels in the DDB treated cells, suggesting, that DDB affects the synthesis and/or degradation of ALT in liver cells. In conclusion, the normalization of ALT during DDB treatment does not indicate therapeutic efficacy. In view of the wide use of DDB in patients with chronic liver diseases who participate in clinical studies DDB use should be excluded.