Milk Thistle Research
41 peer-reviewed studies · Evidence score: 9/10
Preventing Hand-Foot Syndrome in Patients With Cancer: A Systematic Review and Network Meta-Analysis
Baskarane H et al. • JAMA dermatology (2026)
In this systematic review and network meta-analysis, diclofenac and silymarin were the most effective preventive strategies for HFS, with silymarin requiring confirmation in a larger randomized trial.
- Compared with placebo, topical silymarin (OR, 0.08; 95% CI, 0.01-0.71), diclofenac (OR, 0.23; 95% CI, 0.08-0.62), 400-mg pyridoxine (OR, 0.28; 95% CI, 0.09-0.88), and celecoxib (OR, 0.41; 95% CI, 0.18-0.95) significantly reduced grade 2 or higher HFS.
- Diclofenac (OR, 0.30; 95% CI, 0.13-0.69) and celecoxib (OR, 0.46; 95% CI, 0.22-0.94) also reduced overall HFS incidence.
- In contrast, silymarin and 400-mg pyridoxine did not show benefit for overall HFS, while mapisal increased HFS risk (OR, 3.04; 95% CI, 1.07-8.64).
Clinical Efficacy of Curcumin, Resveratrol, Silymarin, and Berberine on Cardio-Metabolic Risk Factors Among Patients With Type 2 Diabetes Mellitus: A Systemic Review and Bayesian Network Meta-Analysis
Miao R et al. • Phytotherapy research : PTR (2025)
However, further validation of these findings is necessary through extensive clinical studies with larger sample sizes.© 2025 John Wiley & Sons Ltd.
- For HbA1c, silymarin was more effective than resveratrol (MD -2.08, 95%Cl -3.50 to -0.72) (P < 0.05).
- For body mass index (BMI), curcumin was more effective than resveratrol (MD -1.27, 95%Cl -2.43 to -0.03) (P < 0.05).
- Curcumin, resveratrol, silymarin, and berberine can effectively improve cardio-metabolic risk factors in T2DM, and different herbal phytochemicals have different clinical advantages.
Are alterations needed in Silybum marianum (Silymarin) administration practices? A novel outlook and meta-analysis on randomized trials targeting liver injury
Shahsavari K et al. • BMC complementary medicine and therapies (2025)
This meta-analysis examined the effects of Milk Thistle.
- According to the findings of this meta-analysis silymarin administration showed a significant reduction in AST (SMD [95% CI]: - 0.670 [- 0.931, - 0.408], p-value = 0.000), and ALT (SMD [95% CI]: - 0.912 [- 1.177, - 0.646], p-value = 0.000) levels.
- While it had no statistically significant effect on ALP level (SMD [95% CI]: - 0.236 [- 1.929, 1.458], p-value = 0.159).
- The subgroup analysis was also showed significant decrease in AST and ALT levels for patients with BMI less than 30, while silymarin treatment had no significant effects on AST and ALT levels in patients with BMI ≥ 30.
Effects of different natural products in patients with non-alcoholic fatty liver disease-A network meta-analysis of randomized controlled trials
Liu H et al. • Phytotherapy research : PTR (2024)
This study may help guide clinicians and lead to further detailed studies.© 2024 John Wiley & Sons Ltd.
- The results of the network meta-analysis showed that artichoke leaf extract confers a relative advantage in reducing the aspartate aminotransferase (AST) levels (SUCRA: 99.1%), alanine aminotransferase (ALT) levels (SUCRA: 88.2%) and low-density lipoprotein cholesterol (LDL-C) levels (SUCRA: 88.9%).
- Naringenin conferred an advantage in reducing triglyceride (TG) levels (SUCRA: 97.3%), total cholesterol (TC) levels (SUCRA: 73.9%), and improving high-density lipoprotein cholesterol (HDL-C) levels (SUCRA: 74.9%).
- High-density catechins significantly reduced body mass index (BMI) levels (SUCRA: 98.5%) compared with the placebo.
Administration of silymarin in NAFLD/NASH: A systematic review and meta-analysis
Li S et al. • Annals of hepatology (2024)
Silymarin can regulate energy metabolism, attenuate liver damage, and improve liver histology in NAFLD patients.
- In addition, silymarin attenuated liver injury as indicated by the decreased levels of ALT (SMD[95%CI]=-12.39[-19.69, -5.08]) and AST (SMD[95% CI]=-10.97[-15.51, -6.43]).
- The levels of fatty liver index (SMD[95%CI]=-6.64[-10.59, -2.69]) and fatty liver score (SMD[95%CI]=-0.51[-0.69, -0.33]) were also decreased.
- Liver histology of the intervention group revealed significantly improved hepatic steatosis (OR[95%CI]=3.25[1.80, 5.87]).
A network meta-analysis on the comparative effect of nutraceuticals on lipid profile in adults
Osadnik T et al. • Pharmacological research (2022)
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- Evidence for bergamot effect was based on relatively small study group and may require further investigations.
- Policosanols have no effect on the lipid profile.Copyright © 2022 The Authors.
- Published by Elsevier Ltd..
Efficacy and safety of dietary polyphenol supplementation in the treatment of non-alcoholic fatty liver disease: A systematic review and meta-analysis
Yang K et al. • Frontiers in immunology (2022)
Based on current evidence, curcumin can reduce BMI, TG, TC, liver enzymes, and insulin resistance; catechin can reduce BMI, insulin resistance, and TG effectively; silymarin can reduce liver enzymes.
- Based on current evidence, curcumin can reduce BMI, TG, TC, liver enzymes, and insulin resistance; catechin can reduce BMI, insulin resistance, and TG effectively; silymarin can reduce liver enzymes.
- For resveratrol, naringenin, anthocyanin, hesperidin, and catechin, more RCTs are needed to further evaluate their efficacy and safety.
- Further research warranted to confirm findings
The effect of medicinal plants on cirrhosis: A systematic review of clinical trials
Amini S et al. • Phytotherapy research : PTR (2023)
However, due to the limited number of studies, further high-quality studies are warranted.© 2023 John Wiley & Sons Ltd.
- An article including four patients investigated the effect of ginseng on cirrhosis; two patients reported improvement in the Child-Pugh score, and ascites decreased in two.
- All studies included here reported no or negligible side effects.
- Results showed that medicinal plants including silymarin, curcumin, and ginseng have beneficial effects on cirrhosis.
Prevention and management of idiosyncratic drug-induced liver injury: Systematic review and meta-analysis of randomised clinical trials
Niu H et al. • Pharmacological research (2021)
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- In management RCTs, the efficacy parameter was usually 50 % decrease or normalisation of liver enzymes, or survival rate in DILI-related ALF patients.
- In conclusion, heterogeneity among studies in DILI case qualification and methodologic quality was evident, and the RCTs performed demonstrated limited efficacy of specific interventions.
- International research networks are needed to establish a framework on RCTs design and therapeutic endpoints.Copyright © 2021 The Authors.
Efficacy of silymarin as an adjuvant in hepatic disorders: A systematic review and meta-analysis of clinical trials
Kalopitas G et al. • Journal of Clinical Gastroenterology (2021)
Silymarin supplementation significantly reduced ALT and AST levels in patients with liver diseases compared to placebo.
- Silymarin significantly reduced serum ALT levels (weighted mean difference -7.53 U/L)
- AST levels were also significantly reduced with silymarin supplementation
- Silymarin was well-tolerated with adverse event rates similar to placebo
Silymarin in non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials
Zhong S et al. • Clinical Nutrition ESPEN (2021)
Silymarin significantly improved liver enzyme levels and hepatic steatosis in NAFLD patients.
- Silymarin reduced ALT by a weighted mean difference of -10.55 IU/L vs placebo
- Significant improvements in hepatic steatosis on imaging
- No significant differences in adverse events between silymarin and placebo groups
Effects berberine-silymarin on liver enzymes: A systematic review and meta-analysis of randomized controlled trials
Mohtashaminia F et al. • Clinical nutrition ESPEN (2022)
We did not find any significant reduction in liver enzymes following BBR-silymarin consumption in adults.
- Berberis aristate and Silybum marianum resulted in no statistically significant change in ALT (weighted mean differences (WMD): -0.39 mg/dl; 95% CI: -1.67 to 0.89, P = 0.55), and AST (WMD: -0.44 mg/dl; 95% CI: -2.02 to 1.14, P = 0.58).
- We did not find any significant reduction in liver enzymes following BBR-silymarin consumption in adults.
- Further clinical trials with high quality according to the challenges mentioned seem to be helpful to use BBR-silymarin as a supplement for improving liver function.
Prophylactic Therapy of Silymarin (Milk Thistle) on Antituberculosis Drug-Induced Liver Injury: A Meta-Analysis of Randomized Controlled Trials
Tao L et al. • Canadian journal of gastroenterology & hepatology (2019)
Prophylactic therapy of silymarin is contributed to a noticeably reduced risk of development of anti-TB DILI four weeks after the initiation.
- Overall, silymarin significantly reduced the occurrence of anti-TB DILI at week 4 [RR: 0.33, 95% CI (0.15, 0.75)].
- In addition, silymarin exerted protective effect on liver function in patients undergoing anti-TB drugs [SMD = - 0.15, 95% CI (-0.24, -0.07), P < 0.001 (ALT); SMD =-0.14, 95% CI (-0.23, -0.06), P = 0.001(AST); SMD =-0.12, 95% CI (-0.20, -0.03), P = 0.008 (ALP)].
- Silymarin led to similar AEs in placebo groups [OR: 1.09, 95% CI (0.86, 1.39), P = 0.47].
Metabolic effect of berberine-silymarin association: A meta-analysis of randomized, double-blind, placebo-controlled clinical trials
Fogacci F et al. • Phytotherapy research : PTR (2019)
The present findings suggest that the coadministration of berberine and silymarin is associated with an advantageous improvement in lipid and glucose profile, suggesting the possible use of this nutraceutical combination in order to promote the cardiometabolic health.© 2019 The Authors Phytotherapy Research Published by John Wiley & Sons Ltd.
- Quantitative data synthesis was performed using a random-effects model.
- We identified five eligible RCTs, with 497 subjects overall included.
- Further research warranted to confirm findings
Pharmacotherapy for trichotillomania
Hoffman J et al. • The Cochrane database of systematic reviews (2021)
There was insufficient evidence from meta-analysis to confirm or refute the efficacy of any agent or class of medication for the treatment of TTM in adults, children or adolescents.
- Antioxidants versus placebo in adolescents There was little to no difference in treatment response between antioxidant (50%) and placebo groups (25%) after six weeks, based on a single trial of silymarin (RR 2.00, 95% CI 0.28 to 14.20; 8 participants; low-certainty evidence).
- Antipsychotics versus placebo in adults There may be greater treatment response in the antipsychotic group (85%) compared to the placebo group (17%) after 12 weeks, based on a single trial of olanzapine (RR 5.08, 95% CI 1.4 to 18.37; 25 participants; low-certainty evidence).
- Cell signal transducers versus placebo in adults There was little to no difference in treatment response between cell signal transducer (42.1%) and placebo groups (31.6%) after 10 weeks, based on a single trial of inositol (RR 1.33, 95% CI 0.57 to 3.11; 38 participants; low-certainty evidence).
Efficacy of oral and topical antioxidants in the prevention and management of oral mucositis in head and neck cancer patients: a systematic review and meta-analyses
Raza A et al. • Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
Though oral and topical antioxidants significantly improved mucositis severity scores in HNC patients receiving radiotherapy with/without chemotherapy in individual studies, the quality of the evidence was low due to the small number of studies and unclear/high-risk bias.
- Included studies showed a statistically significant improvement in mucositis severity score for all antioxidants except melatonin.
- Patients receiving vitamin E were 60% less likely to develop severe mucositis grade 2 or higher than those receiving placebo in one study (P = 0.040).
- Patients receiving zinc were 95% less likely to develop severe mucositis (grades 3-4) in one study compared to placebo (P = 0.031).
Polyphenol Intervention Ameliorates Non-Alcoholic Fatty Liver Disease: An Updated Comprehensive Systematic Review
Ranneh Y et al. • Nutrients (2024)
Still, the inconsistent results across the included RCTs require further clinical research to establish optimal dosage and duration.
- Most studies on silymarin showed a reduction in liver enzymes and lipid profile; however, no changes were observed in inflammatory cytokine levels.
- The dietary supplementation of hesperidin and naringenin or green tea extract caused improvements in liver enzyme, lipid profile, and inflammatory cytokine, while genistein supplementation did not modulate blood lipid profile.
- In conclusion, dietary supplementation of polyphenols could potentially prevent and ameliorate NAFLD.
Effects of silymarin supplementation on liver and kidney functions: A systematic review and dose-response meta-analysis
Mohammadi S et al. • Phytotherapy research : PTR (2024)
Additional high-quality RCTs with longer durations are required to determine the clinical efficacy of SIL supplementation on renal and oxidative stress markers.© 2024 John Wiley & Sons Ltd.
- In addition, there was a nonsignificant decrease in serum levels of gamma-glutamyl transferase, malondialdehyde (MDA), total bilirubin, albumin (Alb), total antioxidant capacity, and blood urea nitrogen.
- Sub-group analyses revealed a considerable decline in MDA and Alb serum values among SIL-treated participants with liver disease in trials with a longer duration (≥12 weeks).
- These findings suggest that SIL may ameliorate certain liver markers with potential hepatoprotective effects, specifically with long-term and high-dose supplementation.
Milk thistle for alcoholic and/or hepatitis B or C liver diseases--a systematic cochrane hepato-biliary group review with meta-analyses of randomized clinical trials
Rambaldi A et al. • The American journal of gastroenterology (2005)
Based on high-quality trials, MT does not seem to significantly influence the course of patients with alcoholic and/or hepatitis B or C liver diseases.
- The methodological quality was low: only 23% of the trials reported adequate allocation concealment and only 46% were considered double blind.
- MT versus placebo or no intervention for a median duration of 6 months had no significant effects on all-cause mortality (relative risk (RR) 0.78, 95% confidence interval (CI) 0.53-1.15), complications of liver disease, or liver histology.
- Liver-related mortality was significantly reduced by MT in all trials (RR 0.50, 95% CI 0.29-0.88), but not in high-quality trials (RR 0.57, 95% CI 0.28-1.19).
Comparative Efficacy of Drug Interventions on NAFLD Over 24 Weeks: A Traditional and Network Meta-Analysis of Randomized Controlled Trials
Wang Y et al. • Drugs (2024)
The results of the comprehensive analysis suggested hypoglycemic drug therapy as an effective intervention for NAFLD, with or without diabetes mellitus.
- Improvement of liver fibrosis stage (≥ 1) was observed with obeticholic acid 25 mg/day (OR 2.01, 95% CI 1.35-2.98), lanifibranor 1200 mg/day (OR 2.39, 95% CI 1.19-4.82) and silymarin (OR 4.54, 95% CI 1.18-17.43) in traditional meta-analysis.
- The results of the comprehensive analysis suggested hypoglycemic drug therapy as an effective intervention for NAFLD, with or without diabetes mellitus.
- A prioritized selection of TZDs, vitamin E plus pioglitazone, GLP-1 receptor agonists and FGF-21 analogue may be considered for NASH resolution.