In Children With Nonalcoholic Fatty Liver Disease, Cysteamine Bitartrate Delayed Release Improves Liver Enzymes but Does Not Reduce Disease Activity Scores

Jeffrey B. Schwimmer, Joel E. Lavine, Laura A. Wilson, Brent A. Neuschwander-Tetri, Stavra A. Xanthakos, Rohit Kohli, Sarah E. Barlow, Miriam B. Vos, Saul J. Karpen, Jean P. Molleston, Peter F. Whitington, Philip Rosenthal, Ajay K. Jain, Karen F. Murray, Elizabeth M. Brunt, David E. Kleiner, Mark L. Van Natta, Jeanne M. Clark, James Tonascia, Edward DooStephanie H. Abrams, Sarah Barlow, Ryan Himes, Rajesh Krisnamurthy, Leanel Maldonado, Rory Mahabir, Kimberlee Bernstein, Kristin Bramlage, Kim Cecil, Stephanie DeVore, Kathleen Lake, Daniel Podberesky, Alex Towbin, Stavra Xanthakos, Gerald Behr, Jay H. Lefkowitch, Ali Mencin, Elena Reynoso, Adina Alazraki, Rebecca Cleeton, Saul Karpen, Jessica Cruz Munos, Nicholas Raviele, Miriam Vos, Molly Bozic, Oscar W. Cummings, Ann Klipsch, Sarah Munson, Kumar Sandrasegaran, Girish Subbarao, Kimberly Kafka, Ann Scheimann, Katie Amsden, Mark H. Fishbein, Elizabeth Kirwan, Saeed Mohammad, Cynthia Rigsby, Lisa Sharda, Jose Derdoy, Ajay Jain, Debra King, Pat Osmack, Joan Siegner, Susan Stewart, Susan Torretta, Kristina Wriston, Susan S. Baker, Lixin Zhu, Jonathon Africa, Jorge Angeles, Sandra Arroyo, Hannah Awai, Cynthia Behling, Craig Bross, Janis Durelle, Michael Middleton, Kimberly Newton, Melissa Paiz, Jennifer Sanford, Claude Sirlin, Patricia Ugalde-Nicalo, Mariana Dominguez Villarreal, Bradley Aouizerat, Jesse Courtier, Linda D. Ferrell, Shannon Fleck, Ryan Gill, Camille Langlois, Emily Rothbaum Perito, Patrika Tsai, Kara Cooper, Simon Horslen, Evelyn Hsu, Karen Murray, Randolph Otto, Matthew Yeh, Melissa Young, Kathryn Fowler, Sherry Brown, Edward C. Doo, Jay H. Hoofnagle, Patricia R. Robuck, Averell Sherker, Rebecca Torrance, Patricia Belt, Michele Donithan, Erin Hallinan, Milana Isaacson, Kevin P. May, Laura Miriel, Alice Sternberg, Ivana Vaughn, Laura Wilson, Katherine Yates

Research output: Contribution to journalArticlepeer-review


Background & Aims No treatment for nonalcoholic fatty liver disease (NAFLD) has been approved by regulatory agencies. We performed a randomized controlled trial to determine whether 52 weeks of cysteamine bitartrate delayed release (CBDR) reduces the severity of liver disease in children with NAFLD. Methods We performed a double-masked trial of 169 children with NAFLD activity scores of 4 or higher at 10 centers. From June 2012 to January 2014, the patients were assigned randomly to receive CBDR or placebo twice daily (300 mg for patients weighing ≤65 kg, 375 mg for patients weighing >65 to 80 kg, and 450 mg for patients weighing >80 kg) for 52 weeks. The primary outcome from the intention-to-treat analysis was improvement in liver histology over 52 weeks, defined as a decrease in the NAFLD activity score of 2 points or more without worsening fibrosis; patients without biopsy specimens from week 52 (17 in the CBDR group and 6 in the placebo group) were considered nonresponders. We calculated the relative risks (RR) of improvement using a stratified Cochran–Mantel–Haenszel analysis. Results There was no significant difference between groups in the primary outcome (28% of children in the CBDR group vs 22% in the placebo group; RR, 1.3; 95% confidence interval [CI], 0.8–2.1; P =.34). However, children receiving CBDR had significant changes in prespecified secondary outcomes: reduced mean levels of alanine aminotransferase (reduction, 53 ± 88 U/L vs 8 ± 77 U/L in the placebo group; P =.02) and aspartate aminotransferase (reduction, 31 ± 52 vs 4 ± 36 U/L in the placebo group; P =.008), and a larger proportion had reduced lobular inflammation (36% in the CBDR group vs 21% in the placebo group; RR, 1.8; 95% CI, 1.1–2.9; P =.03). In a post hoc analysis of children weighing 65 kg or less, those taking CBDR had a 4-fold better chance of histologic improvement (observed in 50% of children in the CBDR group vs 13% in the placebo group; RR, 4.0; 95% CI, 1.3–12.3; P =.005). Conclusions In a randomized trial, we found that 1 year of CBDR did not reduce overall histologic markers of NAFLD compared with placebo in children. Children receiving CBDR, however, had significant reductions in serum aminotransferase levels and lobular inflammation. no: NCT01529268.

Original languageEnglish (US)
Pages (from-to)1141-1154.e9
Issue number6
StatePublished - Dec 1 2016


  • ALT
  • AST
  • Obesity
  • Pediatrics

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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