Evaluation of treatment with zinc acetate hydrate in patients with liver cirrhosis complicated by zinc deficiency

Itaru Ozeki, Tomoaki Nakajima, Hirokazu Suii, Ryoji Tatsumi, Masakatsu Yamaguchi, Tomohiro Arakawa, Yasuaki Kuwata, Joji Toyota, Yoshiyasu Karino
Hepatology Research: the Official Journal of the Japan Society of Hepatology 2019 November 14

AIM: In Japan, no zinc preparation had been approved for therapeutic purposes. Zinc acetate hydrate was recently approved for the treatment of hypozincemia. We evaluated the efficacy and safety of treatment with zinc acetate hydrate.

METHODS: A total of 97 patients with cirrhosis complicated by hypozincemia were treated with zinc acetate hydrate and their serum zinc normalization rates; factors contributing to normalization; changes in blood ammonia levels; branched-chain amino acids to tyrosine ratios (BTR); levels of albumin, hemoglobin, alkaline phosphatase (ALP), serum copper, and iron; incidence of adverse events; improvement in subjective symptoms; and serum zinc levels determined at 3 months post-treatment were determined.

RESULTS: The cumulative serum zinc normalization rates, when normalization was defined as achievement of a serum zinc level ≥ 80 μg/dL, after 2, 4, and 6 months of treatment were 64.9%, 80.3%, and 82.5%, respectively. Multivariate analysis identified an albumin level of ≥ 3.3 g/dL and BTR of ≥ 3.46 as factors contributing to zinc normalization within 3 months of treatment. Treatment resulted in a significant decrease in blood ammonia and serum copper levels and significant increases in BTR and ALP levels. Seven (7.2%) patients prematurely discontinued treatment due to hypocupremia. By the end of treatment, subjective symptoms had resolved in 46.2% of patients. By 3 months post-treatment, serum zinc levels had reverted to levels close to those at baseline.

CONCLUSION: Treatment with zinc acetate hydrate resulted in normalization of serum zinc levels at a high rate. The main reasons for discontinuation of treatment included hypocupremia.

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