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News

Robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis

Biochemical criteria at 1 year are not robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis, reports December's issue of the Alimentary Pharmacology & Therapeutics.

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In primary biliary cirrhosis (PBC), biochemical criteria at 1 year are considered surrogates of response to ursodeoxycholic acid (UDCA).

However, due to the slow natural history of PBC, evaluation at 1 year may be suboptimal to assess the therapeutic response, particularly in early disease.

Professor Burroughs and colleagues from the United Kingdom determined whether evaluation of biochemical criteria at 1 year is a reliable surrogate of UDCA response in early PBC.

The researchers analyzed the prospectively collected data of 215 patients with early PBC, and a median follow-up of 8 years.

Paris-I criteria were predictive of long-term outcomes in untreated patients
Alimentary Pharmacology & Therapeutics

The 1-year attainment rates of the Barcelona, Paris-I, Paris-II and Toronto definitions, and their predictive relevance for a poor outcome were assessed either as a result of UDCA or no treatment.

Independent associations with attaining each UDCA response definition were identified by multivariate analysis.

The team found that untreated patients displayed 1-year biochemical features compatible with ‘treatment response’ at rates similar to those obtained under UDCA.

Depending on the definition, baseline ALP≤3xULN, AST≤2xULN, and early histological stage were the stronger predictors for attaining the criteria.

UDCA treatment was associated with attaining Barcelona, and Paris-II, but not Paris-I, and not Toronto definition when excluding late histological cases.

The team observed that the Paris-I criteria were significantly predictive of long-term outcomes in untreated patients.

Professor Burroughs' team concludes, "In early PBC, biochemical criteria at 1 year reflect severity of the disease rather than the therapeutic response to UDCA."

Aliment Pharmacol Ther 2013: 38(11-12): 1354–1364
21 November 2013

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