The global prevalence of chronic liver diseases (CLD) is steadily increasing, with the most common etiologies being metabolic disorders and alcohol misuse. Despite the effectiveness of non-pharmacological interventions, their impact is often insufficient.
OBJECTIVE
To conduct a clinical and epidemiological analysis of common forms of CLD —nonalcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), and drug-induced liver injury (DILI) — in outpatient practice, and to assess the use of hepatotropic agents, including combination therapy with glycyrrhizic acid and phospholipids (GA+PL).
MATERIAL AND METHODS
The multicenter PROMETHEUS study comprised two stages: a retrospective analysis of 9.149 medical records and a prospective non-interventional observation of 574 patients treated with GA+PL (Phosphogliv). Changes in biochemical liver function parameters, treatment tolerability, and adverse event rates were evaluated.
RESULTS
NAFLD accounted for 72.8% of cases, ALD for 20.1%, and DILI for 7.1%. Comorbidities were present in 90% of patients, and non-pharmacological interventions were prescribed in 95.1%. Monotherapy with hepatotropic agents was associated with reductions in ALT and AST levels (ΔALT 17.28±17.46 U/L; ΔAST 15.04±15.45 U/L). Combination therapy with GA+PL achieved normalization of ALT, AST, and ALP in patients with initially elevated enzyme levels within comparable time frames (p<0.05). At the end of GA+PL therapy, AST normalized in 69% of patients and ALT in 45%. A stepwise regimen (parenteral followed by oral administration) resulted in ALT normalization in 53.5% of patients after a 3-week course. Subjective improvement was reported by over 99% of patients, while the incidence of adverse events was 0.03%.
CONCLUSIONS
In outpatient practice, NAFLD predominates among CLD cases. Monotherapy with hepatotropic agents reduces liver enzyme activity, while combination therapy with GA+PL yields greater improvements in clinical and biochemical parameters. A stepwise regimen shortens treatment duration without compromising efficacy.
