Probably not (Hepatology 2012; 56: 922-32).
Because bile acid sequestrants like colesevelam (& cholestyramine) lower plasma low density lipoprotein (LDL) levels and can improve glycemic control, a recent study tested the hypothesis that this would result in improvement in patients with biopsy-proven nonalcoholic steatohepatitis (NASH).
Methods: 50 patients were randomly assigned to either colesevelam 3.75 g/d or placebo for 24 weeks. All patients had a liver biopsy within 6 months as a baseline study. The primary outcome was liver fat as measured by a MRI technique (proton-density fat-fraction or PDFF) and by MR spectroscopy. At the start and conclusion of the study patients had biochemical assays, MRI-PDFF & MR spectroscopy; also, patients had a liver biopsy at completion of study.
Results: The colesevelam group had increased fat at the conclusion of the study period by a mean difference of 5.6% with PDFF and 4.9% with MR spectroscopy, both compared with placebo group. In addition, liver biopsy did not detect any effect of treatment. Looking at the biochemical indices, there was also a trend of increased transaminases in the treatment group compared to the control group (Table 3 in study).
Conclusions: The authors indicate that the increased fat may be due to a compensatory increase in bile acid synthesis. Also, as the changes in fat were only detected on MRI, future NASH studies may benefit from this technique as well.
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