study to compare the efficacy & safety of ursoplus capsules vs. udca vs. placebo among chronic liver disease patients

Conditions: Chronic Liver Disease

Summary: this study aims to compare the efficacy \& safety of ursoplus® capsules (udca 250mg \& silymarin 140mg) versus udca alone versus placebo among compensated chronic liver diseased patients

research question: compare the efficacy \& safety of ursoplus® capsules (udca 250mg \& silymarin 140mg) versus udca alone versus placebo among compensated chronic liver diseased patients primary objective: to assess the efficacy of ursoplus® capsules (udca 250mg \& silymarin 140mg) versus udca 250mg alone and versus placebo in the reduction of total serum bilirubin, direct serum bilirubin and elevated liver enzymes from baseline to end of treatment (eot) secondary objectives: * to assess the efficacy of ursoplus® capsules (udca 250mg \& silymarin 140mg) versus udca 250 mg alone and versus placebo in reducing the degree of steatosis as measured by vibration-controlled transient elastography with controlled attenuation parameter (cap) * to assess the safety of ursoplus® capsules (udca 250mg \& silymarin 140mg) versus udca 250 mg alone and versus placebo among compensated chronic liver diseased patients * to describe improvement in quality of life for patients after treatment a study population of 297 patients suffering from compensated chronic liver disease, who will be randomized according to vibration-controlled transient elastography in screening visit into 2 groups: * group 1: with non-cirrhosis, f0, f1 and f2. * group 2: with advanced fibrosis and cirrhosis, f3 and f4. each group will receive either ursoplus® capsules (udca 250mg \& silymarin 140mg), or udca alone or placebo, through stratified random sampling. duration for enrollment: 6 months total duration of the study/subject will be approximately: 6 months for treatment and follow-up visits including the screening visit subjects will be enrolled for a duration of 6 months including the screening visit * screening visit 1 (treatment initiation) * visit 2: after 1st month, follow-up 1 * visit 3: after 2nd month, follow-up 2 * visit 4: after 3rd month, follow-up 3 * visit 5: after 4th month, follow-up 4 * visit 6: after 5th month, follow-up 5 * end of study visit, after 6th month of treatment, follow-up 6

Eligibility criteria:
inclusion criteria: 1. male and female patients aged ≥ 18 2. subjects with compensated chronic liver disease, defined as child 5-7. 3. patients with mild disturbance of liver biochemical profile (elevated total serum bilirubin ≤ 3 mg/dl, or elevated direct serum bilirubin ≤ 2 mg/dl, or elevated one or more of liver enzymes, up to 3 times of the normal level (alanine transaminase (alt), aspartate aminotransferase (ast), alkaline phosphatase (alp) \& gamma glutamyl transpeptidase (ggt)). 4. non-diabetic subjects and subjects with controlled dm-type 1 and 2 patients, hba1c up to 7.5% 5. non-pregnant or lactating female patients 6. subjects who are willing to sign informed consent form (icf) and ready to comply with the protocol for the duration of the study exclusion criteria: 1. subjects with a history of hypersensitivity to any of the ingredients of the medications being studied 2. subjects with positive pcr/or antibodies to hepatitis c in the past 6 months 3. subjects with positive hepatitis b surface antigen (hbsag) 4. subjects with elevated liver enzymes more than 3 times of the normal level alanine transaminase (alt), aspartate aminotransferase (ast), alkaline phosphatase (alp) \& gamma glutamyl transpeptidase (ggt). 5. subjects with primary biliary cirrhosis (pbc) and primary sclerosing cholangitis (psc). 6. subjects with child pugh score more than 7. 7. subjects with history of bleeding varices. 8. subjects having uncontrolled diabetes (hba1cmore than 7.5 %) 9. subjects with any medical condition requiring the usage of medication that may interfere with the absorption, distribution, metabolism or excretion of the study drug such as: 1. bile acid sequestering agents such as cholestyramine and colestipol. 2. antacids containing aluminum hydroxide. 3. drugs affecting lipid metabolism such as estrogens, oral and hormonal contraceptives, and clofibrate (and perhaps other lipid-lowering drugs) 10. subjects who are receiving other liver support drugs (including drugs of the study), 1 month before study initiation. 11. subjects with auto immune liver disease taking corticosteroid or immune suppressant 12. pregnant or breast-feeding women 13. use of oral contraceptives in child bearing ladies