A89 CHARACTERISTICS AND CONFLICTS OF INTEREST AT FOOD AND DRUG ADMINISTRATION GASTROINTESTINAL DRUG ADVISORY COMMITTEE MEETINGS

Background

The United States Food and Drug Administration (FDA) Gastrointestinal Drug Advisory Committee (GIDAC) is involved in gastrointestinal drug application reviews. Characteristics and conflicts of interest (COI) in GIDAC meetings are not well described.

Aims

To analyze FDA GIDAC meetings and characteristics that predict recommendations.

Methods

This was a cross-sectional study of all publicly available GIDAC meetings where proposed medications were voted on from 1998–2018. Data were collected on individual meetings and individual voting members at meetings. Predefined predictor variables included type of medication, medication sponsor, primary efficacy studies, and voting member characteristics (e.g. committee membership, COI). Univariate analyses were conducted at per-meeting and per-vote levels to assess for predictors of committee recommendation and individual votes respectively.

Results

Thirty-four meetings with 476 individual votes from 1998–2018 were included. Twenty-three (68%) proposals were recommended for approval and 25 (74%) received FDA approval. Most proposals involved >1 primary study (n=27, 79%). At least one voting member had a COI in 24 (71%) of 34 meetings. Twelve (35%) meetings had at least one sponsor COI. Among 476 individual votes, 74 (15.5%) involved a COI, with 33 (6.9%) sponsor COI. COI decreased significantly over time, with more COI in 1996–2000 and 2001–2005 compared to 2006–2010, 2011–2015, and 2016–2020 (p<0.01). There were no significant associations between pre-defined predictors, including COI, and committee level recommendations or individual votes (p>0.05 for all univariate analyses).

Conclusions

The GIDAC reviewed 34 proposals from 1998–2018. The majority were recommended for approval and later approved by the FDA, highlighting the GIDAC’s prominence in the regulatory process. COI are present among GIDAC panelists but decreasing over time and not associated with recommendations.

Funding Agencies

None

A77 A REUSABLE POLYCARBONATE BOX TO DECREASE DROPLET CONTAMINATION DURING UPPER ENDOSCOPY: A SIMULATION-BASED STUDY FOR THE COVID-19 PANDEMIC

Background

Upper gastrointestinal (GI) endoscopic procedures are aerosol-generating, increasing the risk of healthcare workers (HCW) contracting Coronavirus disease 2019 (COVID-19).

Aims

To present a polycarbonate box (EndoBox) designed for use in upper GI endoscopy and evaluate its impact on the contamination of endoscopy staff during simulated procedures.

Methods

Simulated gastroscopies were performed using an upper body simulator placed in left lateral decubitus (LLD) and supine positions. The endoscopist and assistant wore personal protective equipment. Droplet exposure was measured using fluorescent abiotic surrogate particles. Two blinded observers independently viewed images from each scenario to qualitatively evaluate contamination levels. The primary outcome was the level of HCW contamination by droplets generated from a simulated cough with and without the EndoBox on the upper body simulator. The endoscopist’s ergonomic behaviour was also assessed using the Rapid Upper Limb Assessment (RULA) tool.

Results

Without the EndoBox, there was a higher level of contamination on the endoscopist when the upper body simulator is in the LLD position. A higher level of contamination was observed on the assistant when the simulator is in supine position. With the EndoBox, the contamination levels on the endoscopy staff were lower in both LLD and supine scenarios. The endoscopist’s ergonomics were rated 2 to 3 on the RULA tool when using the EndoBox.

Conclusions

The EndoBox reduces macroscopic droplet contamination during simulated gastroscopy. The endoscopist’s risk of musculoskeletal injury remained in the low risk categories as assessed by the RULA tool. Another advantage of the EndoBox design is the arch extending from the bottom that allows for removal of the box without withdrawing the endoscope. This enables rapid access to the patient’s airway if they experience respiratory distress. This study was limited by an inability to assess microscopic contamination and contamination at the level of the port or buttons when suction is applied. Within these limitations, the EndoBox may be a useful adjunct to traditional personal protective equipment.

Funding Agencies

SMHA AFP COVID-Related Innovation Funds

A161 PREVALENCE OF FINANCIAL CONFLICTS OF INTEREST (FCOI) AMONG PROPENSITY-SCORE MATCHED RETROSPECTIVE STUDIES EVALUATING BIOLOGIC THERAPEUTICS FOR IBD

Background

Inflammatory Bowel Disease (IBD) studies have commonly relied on real-world evidence to evaluate different therapies. An emerging idea has been the use of propensity score matching as a statistical method to account for baseline characteristics in IBD patients. In retrospective studies, propensity score matching of patients helps reduce treatment assignment bias and mimic the effects of randomization. Recently, propensity-score matching has become an important tool in IBD studies comparing biologic therapeutics. Biologic medications are among the highest-grossing drugs worldwide, and their pharmaceutical producers make considerable payments to physicians to market them. In spite of this, there is a lack of evidence examining the role of undue industry influence among propensity-score matched comparative studies evaluating biologic therapeutics for IBD.

Aims

Given the documented association between IBD biologics and FCOI, we hypothesize a high burden of FCOI in propensity-score matched studies. The aim of this study was to evaluate the prevalence of disclosed & undisclosed financial conflicts of Interest (FCOI) in propensity-score matched comparison studies evaluating biologics for IBD.

Methods

We developed & ran a librarian-reviewed systematic search on EMBASE, MEDLINE, and Cochrane Library databases for all propensity-score matched retrospective studies comparing biologics for the treatment of IBD. Full-text retrieval & screening was performed on all studies in duplicate. 16 articles were identified. Industry payments to authors were only considered FCOI if they were made by a company producing a biologic that was included in the comparison study. Disclosed FCOI were identified by authors’ interests disclosures in full-texts. Any undisclosed FCOI among US authors were identified using the Centre for Medicare and Medicaid Services (CMS) Open Payments Database, which collects industry payments to physicians.

Results

Based on a preliminary analysis of 16 studies, there was at least one author with a relevant FCOI in 14 (88%) of the 16 studies. 14 studies (88%) had at least one disclosed FCOI, while 6 studies (37.5%) had at least one undisclosed FCOI. Among studies with disclosed FCOI, a mean of 40.2% (SD = 23.4%) of authors/study reported FCOI. Among studies with undisclosed FCOI, a mean of 18.8% (SD = 7.0%) of authors/study reported FCOI. The total dollar value of FCOIs was $1,974,328.3. The median conflict dollar value was $5,576.6 (IQR: $321.6 to $36,394.9).

Conclusions

We found a high burden of undisclosed FCOI (37.5%) among authors of propensity-score matched studies evaluating IBD biologics. Given the potential for undue industry influence stemming from such payments, authors should ensure better transparency with industry relationships.

Funding Agencies

None

A71 RECOMMENDATION REVERSALS IN GASTROENTEROLOGY CLINICAL PRACTICE GUIDELINES

Background

Clinical practice guidelines are evidence-based resources designed to inform clinical decision making. Often, superior evidence will support the inclusion of novel procedures and practices to replace older recommendations. Recommendation reversals occur when (a) superior quality evidence emerges to suggest the harm or non-beneficence of prior recommendations, and (b) that recommendation is not supplanted by a newer one.

Aims

The primary objective of this study was to describe the content, frequency and rationale for recommendation reversals in CPGs published by gastroenterological societies.

Methods

For this meta-epidemiologic study, we considered two criteria to define a recommendation reversal: (a) the more recent CPG makes a recommendation that contradicts a previously accepted practice; and (b) the prior recommendation is not replaced by any novel intervention. We searched CPGs published by 20 major GI societies from 1991- 2019. Guidelines were included if had at least two iterations with the same title and used a valid evidence rating system (such as GRADE). Explicit recommendations which reported definite levels of evidence and strength of recommendation were extracted.

Results

We identified 1022 clinical guidelines from GI societies over 28 years. 292 CPGs were included for data synthesis. 5985 explicit statements were extracted. 12 reversals were confirmed and are summarized in the Table. Six reversals (50.0%) occurred due to studies reporting non-beneficence and 3 (25.0%) occrred due to studies reporting harm. Three recommendations (25.0%) were reversed due to new clinical trials; 3 (25.0%) due to systematic reviews or meta-analyses; and 2 to conform with CPGs of other societies (16.7%).

Conclusions

We describe recommendation reversals made in gastroenterology CPGs, and the reasons thereof. Investigation of recommendation reversals allows for the identification of low-value medical practices. This reinforces the need for GI CPG committees to (1) iteratively review guidelines to re-evaluate recommendations made on low-quality evidence and; (2) refrain from making recommendations when evidence for the same is weak.

Funding Agencies

None

Phytochemical management of root knot nematode (Meloidogyne incognita) kofoid and white chitwood by Artemisia spp. in tomato (Lycopersicon esculentum L.)

In vitro and screen house experiments were conducted to investigate the effectiveness of thirteen phytochemicals from Artemisia elegantissimia and A. incisa on root knot nematode, Meloidogyne incognita in tomato (Lycopersicon esculentum L.) cv. Rio Grande. A positive control (Carbofuran) and negative control (H2O) were also used for comparison. Effectiveness of phytochemicals against juveniles (J2s) mortality and egg hatch inhibition were evaluated after 24, 48 and 72 hours of incubation at three concentrations viz; 0.1, 0.2 and 0.3 mg/mL in vitro conditions. Amongst thirteen phytochemicals, Isoscopletin (Coumarin), Carbofuran and Apigenin (Flavonoid) showed the highest mortality and egg hatch inhibition of M. incognita at all intervals. Inhibition of eggs and J2s mortality were the greatest (90.0%) and (96.0%) at 0.3 mg/mL concentration. Application of phytochemicals caused reduction in number of galls, galling index, and egg masses on tomato plant and enhanced plant growth parameters under screen house conditions. Gall numbers (1.50), galling index (1.00), number of juveniles (4.83) and egg masses (4.00) were greatly reduced and plant growth parameters such as; plant height (28.48 cm), fresh (72.13 g) and dry shoot weights (35.99 g), and root fresh (6.58 g) and dry weights (1.43 g) were increased significantly by using Isoscopletin. In structure activity relationship, juveniles of M. incognita, exhibited variations in their shape and postures upon death when exposed to different concentrations of phytochemicals of Artemisia spp. The present study suggests that Artemisia based phytochemicals possess strong nematicidal effects and can be used effectively in an integrated disease management program against root knot nematodes.

Potential of graphene-based materials to combat COVID-19: properties, perspectives, and prospects

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new virus in the coronavirus family that causes coronavirus disease (COVID-19), emerges as a big threat to the human race. To date, there is no medicine and vaccine available for COVID-19 treatment. While the development of medicines and vaccines are essentially and urgently required, what is also extremely important is the repurposing of smart materials to design effective systems for combating COVID-19. Graphene and graphene-related materials (GRMs) exhibit extraordinary physicochemical, electrical, optical, antiviral, antimicrobial, and other fascinating properties that warrant them as potential candidates for designing and development of high-performance components and devices required for COVID-19 pandemic and other futuristic calamities. In this article, we discuss the potential of graphene and GRMs for healthcare applications and how they may contribute to fighting against COVID-19.

Association of Ramadan Fasting and Clinical Outcomes in Patients With Myasthenia Gravis

This cohort study examines the association of Ramadan fasting with clinical outcomes in patients with myasthenia gravis.

A243 FACTORS ASSOCIATED WITH POOR QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN CLINICAL REMISSION: A CROSS-SECTIONAL STUDY

Background

Inflammatory bowel disease (IBD) is associated with a substantial burden on quality of life (QoL). Functional gastrointestinal disorders such as irritable bowel syndrome (IBS) as well as depression and anxiety are more common in patients with IBD as compared with the general population. Although poorer QoL is correlated with IBS, depression and anxiety in individuals with IBD at times of IBD diagnosis and disease activity, it is unclear what, if any, impact these may have on overall quality of life at times of disease remission.

Aims

We aimed to identify factors associated with poor QoL among Canadian patients with IBD in clinical remission.

Methods

We conducted a prospective, cross-sectional study to determine whether fatigue, depression, anxiety and IBS were associated with lower QoL in patients with IBD in clinical remission. We enrolled patients at a single academic tertiary care center with inactive IBD. All eligible patients completed a series of questionnaires that included questions on demographics, disease activity, anxiety, depression, and the presence of irritable bowel syndrome (IBS) symptoms. Stool samples for fecal calprotectin (FC) were also collected to assess for subclinical inflammation. The primary outcome measure was QoL assessed by the short inflammatory bowel disease questionnaire (SIBDQ), with planned subgroup comparisons for fatigue, anxiety, depression and IBS symptoms.

Results

Ninety-three patients were eligible for inclusion in this study. The median SIBDQ scores were lower in patients with anxiety (P<0.001), depression (P=0.004), IBS symptoms (P<0.001), and fatigue (P=0.018).

Conclusions

In this cross-sectional study, we found that anxiety, depression, fatigue, and IBS-like symptoms were all independently associated with lower QoL among patients with inactive IBD. Importantly, subclinical inflammation as defined by a positive fecal calprotectin in the absence of clinical symptoms did not have an adverse effect on QoL. The findings of this study suggest that patients with IBD would likely benefit from screening for depression, anxiety, fatigue and IBS. Further research is warranted to determine if targeted treatment of these conditions, specifically in patients with quiescent IBD would lead to improved outcomes.

Funding Agencies

None

A143 IMPACT OF A SIMULATION-BASED AUGMENTED REALITY CURRICULUM ON POLYPECTOMY SKILLS AMONG NOVICE ENDOSCOPISTS: A RANDOMIZED CONTROLLED TRIAL

Background

Polypectomy is an essential endoscopic skill. Training in polypectomy has been identified as a major deficiency for endoscopists worldwide as polypectomy occurs ad hoc during a colonoscopy when a polyp is detected, and a lack of standardized curricula. Augmented reality (AR), which superimposes computer-generated images on a user’s view of the world, can address these gaps by standardizing encounters with polyps while completing simulated procedures and enabling polypectomy-specific teaching.

Aims

Evaluate the impact of a simulation-based augmented reality curriculum on polypectomy performance among novice endoscopists.

Methods

This study includes two cohorts of participants from 2019 to 2020. In 2019, participants were randomized into either: (1) a control curriculum, involving 6 hours of simulation-based training (SBT) supplemented by expert feedback, interlaced with 4 hours of small group teaching on the theory of colonoscopy; or (2) the augmented reality curriculum (ARC), in involving the same curriculum with integrated AR, wherein participants engaged with an AR-enhanced video demonstrating relevant therapeutic and pathologic details during polypectomy. The SBT for all participants involved a progressive curriculum starting on a bench-top model and then moving to the EndoVR® virtual reality simulator. The primary outcome was polypectomy-specific performance using the Direct Observation of Polypectomy Skills (DOPyS) tool during a simulated polypectomy after training, with a maximum score of 100.

Results

Demographic characteristics are summarized in Table. In 2019, 21 novice endoscopists were enrolled. Immediately after training, the mean DOPyS score among ARC group participants was 76.2 (SD=17.9) compared to 71.8 (SD=13.2) among control group participants (Figure). In this interim analysis, there was no significant difference between groups. Data analysis will be completed after 2020 participants complete the study.

Conclusions

Interim results show a trend towards improved polypectomy performance with no significant difference. The results of this study have the potential to impact polypectomy education among novices. Simulation-based AR interventions may allow learners to progress towards achieving competency in polypectomy in a risk-free environment prior to first patient contact.

Funding Agencies

None

An anthropometric evaluation of the scapula, with emphasis on the coracoid process and glenoid fossa in a South African population

The exact dimensions of the scapula, including the coracoid process and glenoid fossa, are fundamental in the patho-mechanics of the glenohumeral joint (GHJ); as these structures act as initiators of shoulder movement. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process and glenoid fossa. The morphometric (Linear Tools 2012, 0-150mm, LIN 86500963) and morphological parameters of a total of one hundred and sixty-four (n = 164) dry bone scapulae [Right (R): 80; Left (L): 84, Male (M): 68; Female (F): 96] were recorded. Results: (i) Shape of glenoid fossa: Type 1: (R) 16.5%, (L) 11.0%; Male (M) 20.1%, Female (F) 7.3%; Type 2: (R) 14.0%, (L) 15.2%; (M) 18.3%, (F) 11.0%; Type 3: (R) 18.3%, (L) 25.0%; (M) 27.4%, (F) 15.9%. (ii) Notch type: Type 1: (R) 1.7%, (L) 7.3%; (M) 6.7%, (F) 2.4%; Type 2: (R) 47.0%, (L) 43.9%; (M) 59.2%, (F) 31.7%. (iii) Vertical diameter of glenoid fossa (VD) (mm): (R) 35.2 ± 3.1, (L) 34.9 ± 3.0; (M) 35.3 ± 3.2, (F) 34.6 ± 2.8. (iv) Horizontal diameter 1 (HD1) of glenoid fossa (mm): (R) 18.4 ± 3.3, (L) 17.5 ± 2.9; (M) 18.2 ± 3.3, (F) 17.4 ± 2.6. (v) Horizontal diameter 2 (HD2) of glenoid fossa (mm): (R) 24.5 ± 2.9, (L) 23.6 ± 2.6; (M) 24.2 ± 2.7, (F) 23.7 ± 2.8. (vi) Length of coracoid process (CL) (mm): (R) 41.7 ± 4.7, (L) 41.5 ± 4.9; (M) 42.1 ± 4.7, (F) 40.7 ± 4.8. (vii) Width of coracoid process (CW) (mm): (R) 13.3 ± 1.9, (L) 14.2 ± 11.9; (M) 13.1 ± 1.9, (F) 15.1 ± 14.5. (viii) Coracoglenoid distance (CGD) (mm): (R) 27.4 ± 8.3, (L) 28.2 ± 3.5; (M) 28.2 ± 7.4, (F) 27.0 ± 3.4. In the present study, Type 3 (oval) was observed to be the predominant glenoid fossa shape with a higher incidence in male individuals and on the right side. Although only notch Types 1 (without a notch) and 2 (with one notch) were observed in this study, Type 2 (one notch) was the most prevalent, presenting with a significant p-value (p = 0.019), suggesting that notch Type 1 (without a notch) and 2 (with one notch) are common findings in the right and left side of individuals. The findings observed in this study may provide knowledge regarding the role of the coracoid parameters in etiology of subcoracoid impingement while knowledge on the glenoid fossa parameters and variations are essential for evaluation in shoulder arthroplasty for glenoid fractures and anterior dislocations, and for glenoid prosthesis designs for the South African population.

Integral measurement of spectrum-averaged cross sections of a few threshold reactions induced by fast neutrons of a TRIGA reactor: comparison with integrated data from excitation functions given in various data libraries

Integral cross sections of the reactions 24Mg(n,p)24Na, 27Al(n,p)27Mg, 27Al(n,α)24Na, 58Ni(n,d + np)57Co and 60Ni(n,p)60Co were measured for the first time using the fast neutron spectrum of a TRIGA reactor extending from 0.5 to 20 MeV. The values obtained in this work were comparable with the recommended values for a pure 235U prompt fission spectrum. The measured integral value was utilized for integral test of excitation function of each reaction given in some data libraries, namely ENDF/B-VIII.0, TENDL-2017, IRDFF-1.05 and ROSFOND-2010. The integral measurements are generally consistent with the integrated values within 5 %, except for a few cases, e. g. the reaction 60Ni(n,p)60Co, where the data libraries appear to need improvement.

Green Synthesis of Cr3+ Doped CaIn₂O₄-Carbon Hybrid Nanostructure and Its Light Absorption and Emission Properties

In this research article, we have used a novel route for synthesis of a greenish phosphor C-CaIn₂O₄ doped with Cr³⁺ ions using green plant (aloe vera gel) and measured its light absorption and emission properties. Our main aim was to enhance the light absorption and emission properties of undoped C-CaIn₂O₄ in order to widen its applications. The introduction of CrO₃ ions can produce Cr ion defects that favor charge balance in Cr³⁺:C-CaIn₂O₄ to facilitate its photoluminescence. The effect of doping in core-shell nanostructure can effectively transfer energy from charge-transfer absorption band of optical host material to characteristic transition of Cr³⁺ ions, utilizing more energy from host absorption for the photoluminescence of Cr³⁺ ions. As-prepared Cr³⁺:C-CaIn₂O₄ exhibits two bands at 270 nm and 370 nm, which are shifted to at 265 and 370 nm when it is annealed at higher dosage of Cr³⁺ ions. These are the ligand-to-metal O^2- to Cr³⁺ charge transfer bands. The light-emission is studied in analyzing migration, transfer and recombination processes of light-induced e^--h⁺ pairs. The results are described in correlation to a Cr³⁺:C-CaIn₂O₄ core-shell nanostructure.

Long head of biceps brachii tendon and transverse humeral ligament morphometry and their associated pathology

BACKGROUND

As a dynamic stabiliser and flexor of the glenohumeral joint, the long head of the biceps brachii tendon (LHBBT) is further stabilised by the retinacular activities of the transverse humeral ligament (THL).

MATERIALS AND METHODS

The LHBBT and THL which were obtained from a total of 40 cadaveric upper limb specimens (n = 80; females: 36, males: 44; right: 40, left: 40), were bilaterally dissected and subjected to morphometric evaluation.

RESULTS

The results are in millimetres. LHBBT length: 81.99 ± 21.28 right, 79.73 ± 17.27 left; 79.82 ± 19.66 male, 82.14 ± 19.03 female; LHBBT width: 4.28 ± 1.31 right, 4.67 ± 1.43 left; 4.35 ± 1.17 male, 4.63 ± 1.60 female; THL length: 20.91 ± 5.24 right, 21.19 ± 6.63 left; 21.52 ± 5.71 male, 20.48 ± 5.92 female; THL width: 16.65 ± 6.92 right, 16.63 ± 7.49 left; 16.83 ± 6.65 male, 16.40 ± 7.84 female. With larger LHBBT length observed on the right side and larger LHBBT width observed on the left side; both parameters appeared to be distinctly longer in female individuals. On the contrary, the THL length and width were evidently greater in male individuals, with larger lengths and widths present on the left and right sides respectively.

CONCLUSIONS

These findings may contribute to South African literature and to clinical knowledge as these parameters are important in the successful outcomes of tenotomy, tenodesis and shoulder-related procedures.

Therapeutic role of calcium and vitamin K3 in chemically induced hepatocarcinogenesis - new tools for cancer treatment

HCC has been reported to be immensely occurring carcinoma worldwide. Recent days the mortality occurred due to liver cancer has also been found to be increased at an alarming speed affecting mostly the young patients. The aim of the current study was to decipher the role of calcium and vitamin K3 in the treatment of chemically induced hepatocarcinogenesis in the male Wistar rats. Liver cancer was induced via a subnecrogenic dose of 160 mg/kg body weight, diethylnitrosamine (DENA) when associated with fasting/refeeding in male Wistar rats. It elevated the serum glutamate oxaloacetate (SGOT), serum glutamate pyruvate transaminase (SGPT), alkaline phosphatase (ALP), bilirubin, total cholesterol (CH), triglycerides (TG), alfa-fetoprotein (AFP) and reduced high-density lipoprotein (HDL). Histopathological examination of liver tissue showed marked carcinogenicity of the chemical carcinogen. Food, water intake and animal weights were also assessed, respectively. The animals exposed to DENA showed a significant decrease in the body weight. The elevated levels of serum SGOT, SGPT, ALP, AFP, TC and TG were restored by administration of calcium and Vit K (ad libitum) combination at higher dose than the normal dietary requirement (3 mg/kg) daily for 12 weeks p.o. Physiological and biochemical analysis showed the beneficial effects of calcium and vitamin K3 combination in the animals exposed to DENA. The results deciphered the beneficial effects of calcium and vitamin K3 in combination.

Thiamin Regresses the Anticancer Efficacy of Methotrexate in the Amelioration of Diethyl Nitrosamine-Induced Hepatocellular Carcinoma in Wistar Strain Rats

Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and occurs frequently in patients with liver cirrhosis. HCC is the leading cause of cancer-related mortality around the globe.Aim: This study assessed the effects of thiamin in the anticancer activity of methotrexate (MTX) in diethyl nitrosamine (DEN) induced hepatocellular Carcinoma in Wistar strain male rats.Method: Fifty rats were randomly segregated in five groups with 10 rats in each group. HCC was induced by single intraperitoneal (i.p) dose of DEN (200 mg/kg) and HCC promoter phenobarbital was used in the basal diet (0.05%) for 5 days per week until the termination of the study in all the rats except for the normal control (NC) group. Disease control (DC) was given no treatment, while DM (DEN + MTX) and DT (DEN + thiamin) groups were given MTX (5 mg/kg, i.p per week for 16 weeks) and thiamin (25 mg/kg, orally, daily for 16 weeks), respectively. DMT (DEN + MTX + thiamin) group was given the combined dose of MTX and thiamin. Histopathological study was carried out to confirm the liver function tests such as α-feto protein (AFP), alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TB), and total protein (TP) along with antioxidants vascular endothelial growth factor (VEGF), lipid per-oxidation (LPO), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT).Results: Results showed that liver biomarkers and antioxidants parameters were still abnormal in the DC group while DM group showed significant restoration, but DT group showed less significant normalization. DMT showed mild recovery of these parameters.Conclusion: The mechanism of action of MTX and thiamin is antiparallel to each other and hence their concomitant administration may lead to inefficient anticancer activity of MTX.