Milk thistle for the treatment of liver disease

A systematic review and meta-analysis
  • Bradly P Jacobs
    Requests for reprints should be addressed to Bradly P. Jacobs, MD, MPH, Osher Center for Integrative Medicine, University of California, San Francisco, Box 1726, San Francisco, California 94143, USA
    Osher Center for Integrative Medicine (BPJ, CD), Department of Medicine (BPJ), University of California, San Francisco, San Francisco, California, USA

    Osher Center Department of Clinical Pharmacy (CD), University of California, San Francisco, San Francisco, California, USA
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  • Cathi Dennehy
    Osher Center for Integrative Medicine (BPJ, CD), Department of Medicine (BPJ), University of California, San Francisco, San Francisco, California, USA

    San Antonio Evidence-Based Practice Center (GR,VAL), University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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  • Gilbert Ramirez
    San Antonio Evidence-Based Practice Center (GR,VAL), University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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  • Jodi Sapp
    Veterans Evidence-Based Research (JS,VAL), Dissemination, and Implementation Center, Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, Texas, USA
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  • Valerie A Lawrence
    San Antonio Evidence-Based Practice Center (GR,VAL), University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

    Veterans Evidence-Based Research (JS,VAL), Dissemination, and Implementation Center, Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, Texas, USA
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      Milk thistle, an herbal compound, is the dietary supplement taken most frequently by patients with chronic liver disease. We performed a systematic review of the literature to determine the efficacy and safety of this herb for the treatment of liver disease.


      We searched English and non-English reports through July 1999 using thirteen databases and reference lists, and contacting manufacturers and technical experts. Reviewers independently screened all reports to identify randomized placebo-controlled trials that evaluated milk thistle for the treatment of liver disease. Outcomes of primary interest included mortality, histological findings on liver biopsy specimens, serum aminotransferase and albumin levels, and prothrombin times.


      Fourteen trials met inclusion criteria. Four trials reported outcomes for mortality among 433 participants. The overall summary odds ratio for mortality in the milk thistle group compared with placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.5; P = 0.6). Three trials assessed histology on liver biopsy; study quality was inversely associated with the likelihood of histological benefit for milk thistle compared with placebo. There were no differences in serum alanine aminotransferase, aspartate aminotransferase, or albumin levels, or prothrombin times, among participants assigned to milk thistle compared with those assigned to placebo. The only statistically significant difference was a greater reduction in alanine aminotransferase levels among patients with chronic liver disease assigned to milk thistle (−9 IU/L, 95% CI: −18 to −1 IU/L; P = 0.05), but this reduction was of negligible clinical importance and no longer statistically significant after limiting analyses to studies of longer duration or of higher quality. The frequency of adverse effects was low and, in clinical trials, indistinguishable from placebo.


      Treatment with milk thistle appears to be safe and well tolerated. We found no reduction in mortality, in improvements in histology at liver biopsy, or in biochemical markers of liver function among patients with chronic liver disease. Data are too limited to exclude a substantial benefit or harm of milk thistle on mortality, and also to support recommending this herbal compound for the treatment of liver disease.


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