Фармакоэпидемиологическая оценка гепатотропной терапии в условиях реальной клинической практики

Abstract

Chronic liver diseases are a serious problem and a common cause of suffering and death in all countries. Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver diseases. Alcoholic liver disease (ALD) is a disease that occurs in the case of the long-term alcohol consumption. ALD may show signs of fatty liver (steatosis), alcoholic hepatitis and cirrhosis. Increase in the prevalence of ALD is also related to the increased alcohol consumption inRussia. Viral hepatitis is a global problem leading to disability and death. About 500 million people are infected with hepatitis B or C, one million annually die from liver diseases associated with hepatitis (2.7% of all deaths). The use of essential phospholipids (EPL) as hepatotropic therapy is widespread inRussia. However, the real practice on its use had not been systematically studied. Primary objective was to characterize under conditions of real life, the profile of consecutive outpatients with newly diagnosed or known diagnosis of liver conditions with gastrointestinal symptoms and receiving a treatment with EPL as an adjunctive treatment to standard care. Materials and methods. 2450 patients were included in 98 sites. Non-interventional on therapeutic strategy study consisting of two phases: Phase 1 – a cross-sectional study to assess the profile of patients who are prescribed EPL; Phase 2 (prospective ) – the follow-up study on 20% patients participated in the Phase 1to assess compliance treatment regimen. Study results. Steatosis was the most frequent liver disease (59.7% patients). Hepatic diseases related to obesity was 23.8% patients, hepatic diseases related to diabetes – 336/2450 (13.7%). Chronic viral hepatitis observed in 21.7% cases. Taking into account that 15.8% patients suffered from combined pathology, data describing morbidity structure were the following: isolated hepatic steatosis occurred in 46.7% cases, hepatic diseases related to obesity – in 12.8% and hepatic diseases related to diabetes – at 6.4%, chronic viral hepatitis – at 18.3%. Patients most often complained about feeling of pressure in the right epigastric 74.4%, general weakness and apathy – 1497/2450 (61.1%), abdominal distension – 1438/2450 (58.7%), nausea – 51.9%. Almost a third of patients complained of irritability – 35.8%, headache and muscle pain – 35.4% and lack of appetite – 26.9%. The main non-pharmacologic management measures for liver disease were: diet therapy – 1387/2450 (97.4%), complete refusal of alcohol – 1726/2450 (70.5%), daily exercise of moderate intensity – 1495/2450 (61.0%), complete smoking cessation – 608/2450 (24.8%). Most often prescribed treatment for liver diseases were hepatoprotectors at inclusion visit – 2291/2450 (93.5%), hypotensive – 1201/2450 (49.0%), hypolipidemic – 1060/2450 (43.3%), hypoglycemic – 457/2450 (18.7%) drugs. Lipotropic products administered at 319/2450 (13.0%) cases, detoxifying – in 282/2450 (11.5%), antiviral – in 147/2450 (6.0%) and immunotropic – in 73/2450 (3.0%).