Objective: To synthesize current evidence regarding the hepatoprotective roles of silymarin, artichoke (Cynara scolymus), and curcumin in chronic hepatitis B (HBV) and C (HCV), focusing on clinical efficacy, safety profile, and research gaps.
Methods: A literature search covering the period from 2007 to October 2025 was conducted on major databases using keywords related to chronic hepatitis and the three specified medicinal agents. Clinical trials, meta-analyses, practice guidelines, and translational studies directly relevant to chronic viral hepatitis were selected and synthesized in a narrative format.
Results: Current guidelines consistently affirm antiviral therapy as the cornerstone of chronic hepatitis management. In chronic hepatitis C, large-scale randomized controlled trials and Cochrane reviews indicate that silymarin, even at high doses, does not significantly improve liver enzymes, symptoms, or hard endpoints (cirrhosis, hepatocellular carcinoma, mortality) compared to placebo. Artichoke has not demonstrated benefit in an exploratory study on chronic hepatitis C; favorable data on metabolic liver disease remain insufficient for extrapolation to viral hepatitis contexts. Curcumin exhibits anti-inflammatory, anti-fibrotic, HBV replication-inhibitory, and hepatocarcinogenesis-reducing effects primarily in preclinical models, while clinical evidence remains scarce. All three agents are generally well-tolerated; however, product quality and bioavailability vary significantly.
Conclusion: No human evidence currently supports the use of silymarin, artichoke, or curcumin to replace or delay antiviral therapy in chronic hepatitis. These agents should only be considered as adjunctive measures, necessitating further large-scale clinical trials with standardized preparations and clearly defined virological and histological endpoints.