Prepared by:
San Antonio Evidence-based Practice Center based at the University of Texas Health Science Center at San Antonio
The Veterans Evidence-based Research, Dissemination
Implementation Center, a Veterans Affairs Health Services
Research and Development Center of Excellence
Cynthia Mulrow, M.D., M.Sc.
Program Director
Valerie Lawrence, M.D., M.Sc.
Principal Investigator
Bradly Jacobs, M.D., M.P.H.
Cathi Dennehy, Pharm.D.
Jodi Sapp, R.N.
Gilbert Ramirez, Dr.P.H.
Christine Aguilar, M.D., M.P.H.
Kelly Montgomery, M.P.H.
Laura Morbidoni, M.D.
Jennifer Moore Arterburn, M.T.S.C.
Elaine Chiquette, Pharm.D.
Martha Harris, M.L.S., M.A.
David Mullins
Andrew Vickers, M.D.
Kenneth Flora, M.D., F.A.C.G.
File Name Description Software Version File Size __________________________________________________________________________________________________________ 01front.doc Microsoft Word® Document MS Word® 97 SR-1 43KB 8 pages Contents: Cover Page, Title Page, Preface, Structured Abstract __________________________________________________________________________________________________________ 02cont.doc Microsoft Word® Document MS Word® 97 SR-1 102KB 2 pages Contents: Table of Contents __________________________________________________________________________________________________________ 03summ.doc Microsoft Word® Document MS Word® 97 SR-1 106KB 6 pages Contents: Summary: Overview, Reporting the Evidence, Methodology, Findings, Conclusions, Future Research __________________________________________________________________________________________________________ 04intro.doc Microsoft Word® Document MS Word® 97 SR-1 153KB 8 pages Contents: Chapter 1. Introduction: Scope and Objectives, Effects of Milk Thistle on Hepatic Disease, Clinical Adverse Effects of Milk Thistle, Background, (Figure 1 in separate file), Chemistry and Pharmacokinetics of Milk Thistle, Mechanisms of Milk Thistle, Current Preparations of Milk Thistle, Challenges in Interpreting the Evidence __________________________________________________________________________________________________________ 05fig1.doc Microsoft Word® Document MS Word® 97 SR-1 138KB 1 page Contents: Figure 1. Evidence model: Milk thistle and liver disease (Chapter 1) __________________________________________________________________________________________________________ 06method.doc Microsoft Word® Document MS Word® 97 SR-1 113KB 8 pages Contents: Chapter 2. Methodology: Expert Input, Questions Addressed in Evidence Report, (Table 1 in separate file), Literature Search and Selection Methods, (Table 2 in separate file), (Figure 2 in separate file), Data Abstraction Process __________________________________________________________________________________________________________ 07tab1.doc Microsoft Word® Document MS Word® 97 SR-1 94KB 1 page Contents: Table 1. Key questions and selection criteria for evidence (Chapter 2) __________________________________________________________________________________________________________ 08tab2.doc Microsoft Word® Document MS Word® 97 SR-1 99KB 1 page Contents: Table 2. Electronic sources searched (Chapter 2) __________________________________________________________________________________________________________ 09fig2.doc Microsoft Word® Document MS Word® 97 SR-1 120KB 1 page Contents: Figure 2. Selection process (Chapter 2) __________________________________________________________________________________________________________ 10result.doc Microsoft Word® Document MS Word® 97 SR-1 174KB 16 pages Contents: Chapter 3. Results: Overview of the Evidence; Milk Thistle Preparations and Doses; Figure 3. Distribution of durations of therapy for 16 blinded, placebo-controlled studies; Figure 4. Distribution of doses for 16 placebo-controlled trials; Milk Thistle and Liver Disease; Effectiveness of Different Preparations of Milk Thistle; Exploratory Meta-Analyses Results; (Table 3 in separate file); (Table 4 in separate file); (Table 5 in separate file); (Table 6 in separate file); Adverse Effects of Milk Thistle __________________________________________________________________________________________________________ 11tab3.doc Microsoft Word® Document MS Word® 97 SR-1 111KB 2 pages Contents: Table 3. Outcome measures and followup times for trials of chronic liver disease, chronic liver disease of mixed etiology, and viral liver disease (Chapter 3) __________________________________________________________________________________________________________ 12tab4.doc Microsoft Word® Document MS Word® 97 SR-1 106KB 2 pages Contents: Table 4. Effect sizes and meta-analysis for chronic alcoholic liver disease (6 studies) (Chapter 3) __________________________________________________________________________________________________________ 13tab5.doc Microsoft Word® Document MS Word® 97 SR-1 98KB 1 page Contents: Table 5. Effect sizes and meta-analysis for chronic liver disease of mixed etiologies (6 studies) (Chapter 3) __________________________________________________________________________________________________________ 14tab6.doc Microsoft Word® Document MS Word® 97 SR-1 94KB 1 page Contents: Table 6. Effect sizes and meta-analysis for viral liver disease, acute and chronic (3 studies) (Chapter 3) __________________________________________________________________________________________________________ 15conclu.doc Microsoft Word® Document MS Word® 97 SR-1 91KB 2 pages Contents: Chapter 4. Conclusions __________________________________________________________________________________________________________ 16future.doc Microsoft Word® Document MS Word® 97 SR-1 96KB 2 pages Contents: Chapter 5. Future Research: Adverse Effects, Beneficial Effects Regarding Liver Diseases, Specific Areas of Research __________________________________________________________________________________________________________ 17refs.doc Microsoft Word® Document MS Word® 97 SR-1 120KB 6 pages Contents: References __________________________________________________________________________________________________________ 18smtb1.doc Microsoft Word® Document MS Word® 97 SR-1 105KB 2 pages Contents: Summary Table 1. Placebo-controlled studies of milk thistle for chronic alcoholic liver disease (n = 6) __________________________________________________________________________________________________________ 19smtb2.doc Microsoft Word® Document MS Word® 97 SR-1 106KB 3 pages Contents: Summary Table 2. Placebo-controlled studies of milk thistle for chronic liver disease, mixed etiologies (n = 6) __________________________________________________________________________________________________________ 20smtb3.doc Microsoft Word® Document MS Word® 97 SR-1 93KB 1 page Contents: Summary Table 3. Placebo-controlled studies of milk thistle for acute viral hepatitis __________________________________________________________________________________________________________ 21smtb4.doc Microsoft Word® Document MS Word® 97 SR-1 96KB 1 page Contents: Summary Table 4. Placebo-controlled studies of milk thistle for chronic viral hepatitis __________________________________________________________________________________________________________ 22smtb5.doc Microsoft Word® Document MS Word® 97 SR-1 96KB 1 page Contents: Summary Table 5. Placebo-controlled studies of milk thistle and cirrhosis due to alcohol or other etiologies __________________________________________________________________________________________________________ 23smtb6.doc Microsoft Word® Document MS Word® 97 SR-1 96KB 1 page Contents: Summary Table 6. Placebo-controlled studies of milk thistle and alcoholic cirrhosis (other etiologies of cirrhosis excluded) __________________________________________________________________________________________________________ 24smtb7.doc Microsoft Word® Document MS Word® 97 SR-1 94KB 1 page Contents: Summary Table 7. Placebo-controlled study of milk thistle and toxin-induced liver disease __________________________________________________________________________________________________________ 25smtb8.doc Microsoft Word® Document MS Word® 97 SR-1 95KB 1 page Contents: Summary Table 8. Prophylactic milk thistle with hepatotoxic drugs __________________________________________________________________________________________________________ 26smtb9.doc Microsoft Word® Document MS Word® 97 SR-1 93KB 1 page Contents: Summary Table 9. Phase II study of SilipideR __________________________________________________________________________________________________________ 27smtb10.doc Microsoft Word® Document MS Word® 97 SR-1 111KB 2 pages Contents: Summary Table 10. Effect sizes and meta-analyses of 16 placebo-controlled trials (Evidence Tables 1 and 2) __________________________________________________________________________________________________________ 28smtb11.doc Microsoft Word® Document MS Word® 97 SR-1 110KB 2 pages Contents: Summary Table 11. Effect sizes and meta-analyses of 14 randomized, placebo-controlled trials of higher methodological quality (Evidence Table 1) __________________________________________________________________________________________________________ 29smtb12.doc Microsoft Word® Document MS Word® 97 SR-1 94KB 1 page Contents: Summary Table 12. Adverse effects of oral use of milk thistle, silymarin, or SilipideR __________________________________________________________________________________________________________ 30etab1.doc Microsoft Word® Document MS Word® 97 SR-1 125KB 9 pages Contents: Evidence Table 1. Milk thistle for treatment of liver disease: Placebo-controlled, randomized, blinded trials __________________________________________________________________________________________________________ 31etab2.doc Microsoft Word® Document MS Word® 97 SR-1 95KB 1 page Contents: Evidence Table 2. Milk thistle for treatment of liver disease: Placebo-controlled, prospective trials with unclear blinding __________________________________________________________________________________________________________ 32etab3.doc Microsoft Word® Document MS Word® 97 SR-1 128KB 10 pages Contents: Evidence Table 3. Milk thistle for treatment of liver disease: Studies without placebo controls __________________________________________________________________________________________________________ 33etab4.doc Microsoft Word® Document MS Word® 97 SR-1 94KB 1 page Contents: Evidence Table 4. Milk thistle for prophylaxis against liver disease: Ineligible (normal liver function at study entry) but provocative studies __________________________________________________________________________________________________________ 34etab5.doc Microsoft Word® Document MS Word® 97 SR-1 113KB 5 pages Contents: Evidence Table 5. Milk thistle for treatment of liver disease: Adverse effects __________________________________________________________________________________________________________ 35biblio.doc Microsoft Word® Document MS Word® 97 SR-1 159KB 12 pages Contents: Bibliography __________________________________________________________________________________________________________ 36appa.doc Microsoft Word® Document MS Word® 97 SR-1 102KB 2 pages Contents: Appendix A. Milk Thistle Search Strategies __________________________________________________________________________________________________________ 37appb.doc Microsoft Word® Document MS Word® 97 SR-1 1.3MB 26 pages Contents: Appendix B. Graphic Summaries (Figures 1-1 through 1-45) __________________________________________________________________________________________________________ 38appc.doc Microsoft Word® Document MS Word® 97 SR-1 103KB 6 pages Contents: Appendix C. Contributors __________________________________________________________________________________________________________ 39appd.doc Microsoft Word® Document MS Word® 97 SR-1 90KB 1 page Contents: Appendix D. Acronyms __________________________________________________________________________________________________________
AHRQ Publication No. 01-E025
Current as of October 2000
Internet Citation:
Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects. File Inventory, Evidence Report/Technology Assessment Number 21. AHRQ Publication No. 01-E025, October 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/thistlinv.htm
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