Whether primary biliary cirrhosis-autoimmune hepatitis overlap syndrome requires immunosuppressive therapy in addition to ursodeoxycholic acid is a controversial issue.
Dr Oliver Chazouillères and colleagues from France followed 17 patients with simultaneous form of strictly defined overlap for 8 years.
Group 1 included 11 patients that received first-line treatment with ursodeoxycholic acid alone.
There were 6 patients in Group 2 that received a combination of immunosuppressors and ursodeoxycholic acid.
The researchers noted that characteristics at presentation were not significantly different between the 2 groups.
|Decreased fibrosis was observed in 3 patients with combination therapy|
|Journal of Hepatology|
In Group 2, biochemical response in terms of autoimmune hepatitis features was achieved in 4 out of 6 patients, and fibrosis did not progress.
In Group 1, biochemical response was observed in 3 patients together with stable or decreased fibrosis.
The researchers observed that the 8 others were non-responders with increased fibrosis in 4 patients.
The team noted that 7 of these 8 patients subsequently received combined therapy for 3 years.
Biochemical response was obtained in 6 out of 7 patients and no further increase of fibrosis was demonstrated.
Overall, fibrosis progression in non-cirrhotic patients occurred more frequently under ursodeoxycholic acid monotherapy than under combined therapy.
Dr Chazouillères' team concluded, “Combination of ursodeoxycholic acid and immunosuppressors appears to be the best therapeutic option for strictly defined primary biliary cirrhosis - autoimmune hepatitis overlap syndrome.”