Ursodeoxycholic acid (UDCA) is a safe and effective medical
therapy for most patients with
primary biliary cirrhosis (PBC), but some patients show an incomplete response.
Silymarin is a potent
antioxidant with immunomodulatory and antifibrotic properties. The aim of this study was to evaluate the safety and assess the efficacy of
silymarin in patients with PBC who had shown a suboptimal response to UDCA. Twenty-seven patients with PBC who had been on UDCA (13-15 mg/kg/day)
therapy for 7 to 221 months and had shown a persistent elevation of
alkaline phosphatase activity at least 2 times the upper limit of normal for more than 6 months were enrolled. Oral
silymarin, 140 mg 3 times daily was given for 1 year, and patients continued on the same dosage of UDCA. No significant changes in serum
alkaline phosphatase activity (897 +/- 84 vs. 876 +/- 95, P =.5), total
bilirubin (0.9 +/- 0.1 vs. 1 +/- 0.1, P =.07),
aspartate transaminase (AST) (58 +/- 5 vs. 56 +/- 6, P =.4),
albumin (4.0 +/-.06 vs. 4.1 +/-.06, P =.4), or Mayo risk score (3.82 +/- 0.2 vs. 3.88 +/- 0.2, P =.4) were noted after 1 year of treatment with combination
therapy. Transitory gastrointestinal adverse events occurred in 2 patients. In conclusion, although
silymarin was well tolerated, this medication did not provide benefit to patients with PBC responding suboptimally to UDCA. The results of this pilot study would seem to discourage further controlled trials of
silymarin in patients with PBC.