APRI index changes after 4 weeks treatment of Pentoxifylline in Chronic Hepatitis B


  • Zulfan Zulfan Department of Internal Medicine, YARSI University School of Medicine, Jakarta
  • Lukman Hakim Zain Gastroentero-Hepatology Division, Department of Internal Medicine USU Medical School /Adam Malik Hospital Medan



liver fibrosis, hepatic stellate cell, pentoxifylline, APRI Index


Nowadays studies have shown that liver fibrosis is a reversible process. Theraupetic target on hepatic stellate cell (HSC) through inhibition of fibrotic signaling transduction is one of the way to treat liver fibrosis (e.g. pentoxifylline). APRI index, one of the indirect marker of liver fibrosis, had shown significant correlation (Spearman correlation y = 0.7) with liver fibrosis degree in hepatitis B and C. This study was aimed to evaluate the effect of pentoxifylline treatment in 4 weeks for liver fibrosis measured by APRI index. We conducted clinical trial on eleven chronic hepatitis B patients from Adam Malik Hospital Medan, with positive HBsAg at least 6 months after follow up. They were treated with pentoxifylline for 4 weeks. Before and after treatment, APRI index was measured. The result showed a decrease of ALT (64.64+49.61 vs 50.64+26.13;p=0.28), but AST and APRI index increased (91.82+100.16 vs 97.91+146.75; p=0.79) and (1.17+1.07 vs 1.31+1.84; p=0.96) respectively. It was concluded that the effect of pentoxifylline as antifibrotic in the liver measured by APRI index was not proven. It was shown that APRI index increased after 4 weeks treatment of pentoxifylline.


Arthur MJ 2002. Reversibility of liver fibrosis and cirrhosis following treatment for hepatitis C. Gastroenterol., 122:1525–1528.

Adams LA, Zein CO, Angulo P, Lindor KD 2004. A Pilot trial of pentoxifylline in nonalcoholic steatohepatitis. Am J Gastroenterol., 99:2365 – 2368.

Austin AS, Mahida YR, Clarke D, Ryder SD, Freeman JG 2004. A pilot study to investigate the use of oxpentifylline (pentoxifylline) and thalidomide in portal hypertension secondary to alcoholic cirrhosis. Aliment Pharmacol Ther., 19:79 – 88.

Bataller R, Brenner DA 2005. Liver Fibrosis. J. Clin. Invest., 115:209–218.

Dixon JB, Bhathal PS, Hughes NR, O’Brien PE 2004. Nonalcoholic fatty liver disease: Improvement in liver histological analysis with weight loss. Hepatology., 39:1647–1654.

Gines P, Cardenas A, Arroyo V, Rodes J 2004. Management of cirrhosis and ascites. N. Engl.J. Med., 350:1646–1654.

Hammel P, Couvelard A, O’Toole D, Ratouis A, Sauvanet A, Flejou JF 2001. Regression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. N Engl J Med., 344:418–423.

Hinze HJ, Bedessem G, Soder A 1972. Structure of excretion products of 3,7-dimethyl-1-{5-oxo-hexyl}-xanthine (BL 191) in man. Arzenimittelforsch., 22:1144 – 1151.

Kelleher TB, Afdhal N 2000. Assesment of liver fibrosis in co – infected patients. J Hepatol ., 44:126 – 131.

Lok ASF, McMahon BJ 2007. AASLD Practice Guidelines Chronic Hepatitis B. Hepatology., 45 (2):1 – 34.

Maddrey WC 2000. Hepatitis B: An Important Public Health Issue. J Med Virol., 61:362 – 6.

Mallat A, Preaux AM, Blazejewski S, Rosenbaum J, Dhumeaux D, Mavier P 1995. Interferon alfa and gamma inhibit proliferation and collagen synthesis of human Ito cells in culture. Hepatology., 21:1003 – 1010.

Pares A, Caballeria J, Bruguera M, Torres M, Rodes J 1986. Histological course of alcoholic hepatitis. Influence of abstinence, sex and extent of hepatic damage. J. Hepatol., 2:33–42.

Preaux AM, Mallat A, Rosenbaum J, Zafrani S, Mavier P 1997. Pentoxifylline inhibits growth and collagen synthesis of cultured human hepatic myofibroblast – like cells. Hepatology., 26:315 – 322.

Sataphty SK, Garg S, Chauhan R, Hahn TH, Sakhuja P, Malhotra P, Sharma BC, Sarin SK 2004. Beneficial effects of tumor necrosis a inhibiton by pentoxifylline on clinical, biochemical and metabolic parameters of patients with nonalcoholic steatohepatitis. Am J Gastroenterol., 99: 1946 – 1952.

Sataphty SK, Sakhuja P, Malhotra P, Sharma BC, Sarin SK 2007. Beneficial effects of pentoxifylline on hepatic steatosis, fibrosis and necroinflammation in patients with non-alcoholic steatohepatitis. J Gastroenterol and Hepatol., 26: 634 – 638.

Shin WG, Park SH, Jang MK, Hahn TH, Kim JB, Lee MS 2008. Aminotransferase and platelete ratio index can predict liver fibrosis in chronic hepatitis B. Digestive and Liver Disease.,40: 267–274.

Wu J and Zern MA 2000. Hepatic stellate cells: a target for the treatment of liver fibrosis. J Gastroenterol., 35:665–672.






Research Articles