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Intravenous fish oil effective for pediatric intestinal failure-associated liver disease

Pediatric patients with intestinal failure-associated liver disease may benefit from a regimen of intravenous fish oil, according to recent results.

Researchers administered 1 g/kg per day of intravenous fish oil (FO) to 10 patients with intestinal failure-associated liver disease (IFALD) who received most of their caloric intake via parenteral nutrition (PN) for 24 weeks. Results were compared against those from 20 historic controls treated with intravenous soybean oil (SO).

During a median follow-up of 11.5 weeks in the FO group and 24 weeks in the SO group, estimation via the Kaplan-Meier method predicted 75% resolution in the FO group at 17 weeks of treatment, compared with 6% in the SO group (P<.0001). Biochemical reversal of IFALD would occur in half of patients receiving FO monotherapy in 11.5 weeks.

While median total bilirubin levels at baseline were comparable between groups, FO recipients had significantly lower direct bilirubin at 8 (P=.03), 12, 16, 20 and 24 weeks of treatment (P<.0001 for all), with a similar trend in total bilirubin. AST also decreased among FO patients at 12, 16, 20 and 24 weeks compared with SO patients (P<.001 for all), while ALT fell at 16 and 20 weeks (P<.05).

The two groups did not differ significantly in incidence of death, transplantation, hospital readmission, need for full enteral feeding or normalization of liver function tests. Length of hospital stay also was similar between groups. No FO recipients developed essential fatty acid deficiency, and the groups had similar platelet concentrations and INR values.

Investigators said the study remains open, and long-term follow-up of patients after FO treatment completion will be performed to determine relapse and transplantation rates. “Intravenous fish oil … is considered experimental and is currently available only under special protocols,” researcher Kara L. Calkins, MD, assistant professor in the department of pediatrics at UCLA, said in a press release. “If it proves safe and effective for patients, we hope it would eventually be available for wider use.”

Disclosure: See the study for a full list of relevant financial disclosures.