Effect of Candesartan and Ramipril on Liver Fibrosis in Patients with Chronic Hepatitis C Viral Infection: A Randomized Controlled Prospective Study

Abstract Objective This study aimed at evaluating the effects of Candesartan and Ramipril on liver fibrosis in patients with chronic hepatitis C. Methods This randomized controlled prospective study involved 64 patients with chronic hepatitis C and liver fibrosis. Participants were randomized into three groups; group I (control group; n=21) which received traditional therapy only, group 2 (Ramipril group; n=21) which received traditional therapy plus 1.25 mg/day oral Ramipril and group 3 (Candesartan group; n=22) which received traditional therapy plus 8 mg/day oral Candesartan. Patients were assessed at baseline and 6 months after intervention through measuring of liver stiffness (Fibro-Scan), evaluation of the serum levels of hyaluronic acid (HA) and transforming growth factor-beta 1(TGF-β1) and calculation of indices of liver fibrosis including fibrosis index based on the 4 factors (FIB-4) and aspartate transaminase-to-platelet ratio index (APRI). Data were analyzed using paired t-test and one-way analysis of variance followed by Tukey's HDS test for multiple pairwise comparisons. Results At baseline, the three study groups were statistically similar in demographic and laboratory data. After treatment, the three study groups showed significant decrease in liver stiffness, serum levels HA and TGF-β1, and indices of liver fibrosis as compared to baseline data (p Conclusions The administration of Ramipril and Candesartan in chronic hepatitis C patients with hepatic fibrosis was well tolerated and effective in improving liver fibrosis. AT1-R antagonist Candesartan maintained anti-fibrotic more effectively than Ramipril and may represent a safe and effective therapeutic strategy for liver fibrosis in patients with chronic liver diseases. Clinical trials.gov identifier NCT03770936