Effect of colesevelam on liver fat quantified by magnetic resonance in nonalcoholic steatohepatitis: a randomized controlled trial.
Bile acid sequestrants (BAS) lower plasma low density lipoprotein levels and improve glycemic control. Colestimide, a BAS,
has been claimed by computed tomography to reduce liver fat. Therefore, we examined the efficacy of colesevelam, a potent
BAS, to decrease liver fat in patients with biopsy-proven nonalcoholic steatohepatitis (NASH). Liver fat was measured by a
novel magnetic resonance imaging (MRI) technique, the proton-density-fat-fraction (PDFF), as well as by conventional MR spectroscopy
(MRS). Fifty patients with biopsy-proven NASH were randomly assigned to either colesevelam 3.75 g/day orally or placebo for
24 weeks. The primary outcome was change in liver fat as measured by MRI-PDFF in colocalized regions of interest within each
of the nine liver segments. Compared with placebo, colesevelam increased liver fat by MRI-PDFF in all nine segments of the
liver with a mean difference of 5.6% (P = 0.002). We cross-validated the MRI-PDFF-determined fat content with that assessed
by colocalized MRS; the latter showed a mean difference of 4.9% (P = 0.014) in liver fat between the colesevelam and the placebo
arms. MRI-PDFF correlated strongly with MRS-determined hepatic fat content (r(2) = 0.96, P < 0.0001). Liver biopsy assessment
of steatosis, cellular injury, and lobular inflammation did not detect any effect of treatment.
CONCLUSION: Colesevelam increases liver fat in patients with NASH as assessed by MRI as well as MRS without significant changes seen on histology. Thus, MRI and MRS may be better than histology to detect longitudinal changes in hepatic fat in NASH. Underlying mechanisms and whether the small MR-detected increase in liver fat has clinical consequences is not known.
Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
SourceHepatology (Baltimore, Md.) 56:3 2012 Sep pg 922-32
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Pub Type(s)Journal Article
Randomized Controlled Trial