Resistant nonalcoholic fatty liver disease amelioration with rosuvastatin and pioglitazone combination therapy in a patient with metabolic syndrome
- PMID: 24259612
- DOI: 10.1177/1060028013507239
Resistant nonalcoholic fatty liver disease amelioration with rosuvastatin and pioglitazone combination therapy in a patient with metabolic syndrome
Abstract
Objective: To report a case describing resolution of persistently elevated aminotransferases in a patient with severe, resistant nonalcoholic fatty liver disease (NAFLD) using combination therapy.
Case summary: A 47-year-old obese male patient presented with a history of elevated aminotransferases and numerous statin intolerances. In addition to worsening control of diabetes and dyslipidemia, severe NAFLD was confirmed. Rosuvastatin was started, which induced short-term elevations in aminotransferases resulting in patient discontinuation. Biochemical markers of NAFLD worsened over time. Therefore, both rosuvastatin 20 mg daily and pioglitazone 15 mg daily were started simultaneously to potentially blunt the early increase in transaminases seen with rosuvastatin. At 2 weeks, the patient's alanine aminotransferase (ALT) and aspartate aminotransferase (AST) had decreased 57% and 56% from baseline, respectively. By 9 months, the patient's ALT and AST serum concentrations had normalized. Repeat liver ultrasound demonstrated improvement in steatosis grading and reduction in liver size. These improvements occurred despite a 4.5-kg weight gain since starting rosuvastatin and pioglitazone.
Discussion: Pharmacotherapy in NAFLD is not well validated, particularly combination therapy. Medications that target obesity-related consequences are commonly used, although evidence regarding biochemical and histological improvement is inconclusive. Consideration should be given to the use of combination of thiazolidinediones and statins for rapid biochemical improvement and long-term histological impact.
Conclusions: The improvement in this patient's biochemical and ultrasonographic markers of resistant, severe NAFLD was rapid and sustained with combination therapy. This case represents a potential solution for initiating or maintaining statin therapy in patients with NAFLD who are at high cardiovascular risk.
Keywords: NAFLD; antioxidants; fatty liver; pioglitazone; statin.
Similar articles
-
Ultrasonography modifications of visceral and subcutaneous adipose tissue after pioglitazone or glibenclamide therapy combined with rosuvastatin in type 2 diabetic patients not well controlled by metformin.Eur J Gastroenterol Hepatol. 2013 Sep;25(9):1113-22. doi: 10.1097/MEG.0b013e3283608317. Eur J Gastroenterol Hepatol. 2013. PMID: 23524525 Clinical Trial.
-
A pilot study of pioglitazone treatment for nonalcoholic steatohepatitis.Hepatology. 2004 Jan;39(1):188-96. doi: 10.1002/hep.20012. Hepatology. 2004. PMID: 14752837 Clinical Trial.
-
One-year efficacy and safety of rosuvastatin + fenofibric acid combination therapy in patients with mixed dyslipidemia: evaluation of dose response.Am J Cardiovasc Drugs. 2012 Apr 1;12(2):117-25. doi: 10.2165/11597940-000000000-00000. Am J Cardiovasc Drugs. 2012. PMID: 22263674 Clinical Trial.
-
The use of statins alone, or in combination with pioglitazone and other drugs, for the treatment of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and related cardiovascular risk. An Expert Panel Statement.Metabolism. 2017 Jun;71:17-32. doi: 10.1016/j.metabol.2017.02.014. Epub 2017 Mar 4. Metabolism. 2017. PMID: 28521870 Review.
-
Rosuvastatin-associated adverse effects and drug-drug interactions in the clinical setting of dyslipidemia.Am J Cardiovasc Drugs. 2010;10(1):11-28. doi: 10.2165/13168600-000000000-00000. Am J Cardiovasc Drugs. 2010. PMID: 20104931 Review.
Cited by
-
Resolution of non-alcoholic steatohepatitis by rosuvastatin monotherapy in patients with metabolic syndrome.World J Gastroenterol. 2015 Jul 7;21(25):7860-8. doi: 10.3748/wjg.v21.i25.7860. World J Gastroenterol. 2015. PMID: 26167086 Free PMC article. Clinical Trial.
-
Treatment of nonalcoholic fatty liver disease: Where do we stand? an overview.Saudi J Gastroenterol. 2016 Mar-Apr;22(2):91-105. doi: 10.4103/1319-3767.178527. Saudi J Gastroenterol. 2016. PMID: 26997214 Free PMC article. Review.
-
Dietary blueberry and bifidobacteria attenuate nonalcoholic fatty liver disease in rats by affecting SIRT1-mediated signaling pathway.Oxid Med Cell Longev. 2014;2014:469059. doi: 10.1155/2014/469059. Epub 2014 Nov 27. Oxid Med Cell Longev. 2014. PMID: 25544867 Free PMC article.
-
Combination Treatment of Omega-3 Fatty Acids and Vitamin C Exhibited Promising Therapeutic Effect against Oxidative Impairment of the Liver in Methotrexate-Intoxicated Mice.Biomed Res Int. 2022 Apr 20;2022:4122166. doi: 10.1155/2022/4122166. eCollection 2022. Biomed Res Int. 2022. PMID: 35496049 Free PMC article.
-
Combination Therapies for Nonalcoholic Fatty Liver Disease.J Pers Med. 2022 Jul 18;12(7):1166. doi: 10.3390/jpm12071166. J Pers Med. 2022. PMID: 35887662 Free PMC article. Review.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical