S-Adenosyl-L-methionine in the treatment of patients with intrahepatic cholestasis of pregnancy: A randomized, double-blind, placebo-controlled study with negative results

Authors

  • Dr. Jose Ribalta,

    Corresponding author
    1. Department of Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
    • Departamento de Preclínicas Oriente, Universidad de Chile, Casilla 16038, Santiago 9, Chile
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  • Humberto Reyes,

    1. Department of Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
    2. Department of Experimental Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Manuel C. Gonzalez,

    1. Department of Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Joaquin Iglesias,

    1. Department of Obstetrics, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Marco Arrese,

    1. Department of Experimental Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Jaime Poniachik,

    1. Department of Experimental Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Claudina Molina,

    1. Department of Obstetrics, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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  • Nelly Segovia

    1. Department of Experimental Medicine, University of Chile School of Medicine (Eastern Campus), Hospital del Salvador, Santiago 9, Chile
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Abstract

S-Adenosyl-L-methionine has been reported to induce beneficial effects in intrahepatic cholestasis of pregnancy. Because cholestasis of pregnancy has a high prevalence in Chile and a deleterious effect on fetal prognosis, we decided to verify the efficacy of S-adenosyl-L-methionine in this disease. Eighteen patients with pruritus that appeared during pregnancy and with elevated serum levels of bile salts (68.1 ± 15.9 μmol/L; mean ± S.E.M.) and ALT (226 ± 50 KU/L) were enrolled in a prospective double-blind study comparing the effects of the drug with a placebo. S-Adenosyl-L-methionine, 900 mg, or placebo was administered in daily intravenous infusions for 20 days. Every 5 days liver function tests were done and pruritus was assessed using a preestablished score. No significant differences in pruritus or in serum levels of bile salts, ALT, bilirubin and alkaline phosphatases were seen during or after treatment between patients who received S-adenosyl-L-methionine (n = 9) or placebo (n = 9). No relevant adverse reactions were detected. Most patients had cesarean sections because of reasons unrelated to the therapeutic trial. All newborns had Apgar scores greater than 7 and normal postnatal development. Our patients had moderately severe to severe cholestasis of pregnancy as indicated by the onset of pruritus before wk 32 of pregnancy. Seven of nine multiparous patients had a past history of recurrent cholestasis of pregnancy. In this study, the administration of S-adenosyl-L-methionine during 20 days did not improve intrahepatic cholestasis of pregnancy. (HEPATOLOGY 1991;13:1084–1089.)

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