Long-Term Obeticholic Acid Therapy Improves Histological Endpoints in Patients With Primary Biliary Cholangitis
| Autor: | Christopher L. Bowlus, R. Pencek, Luigi Terracciano, Leigh MacConell, Andreas E. Kremer, Albert Parés, Alexander Liberman, Yuying Jin, Lisa Forman, Pierre Bedossa, Paul J. Pockros, Uche Iloeje, Joost P.H. Drenth, Stephen D. Ryder |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cirrhosis Chenodeoxycholic Acid Gastroenterology 03 medical and health sciences Liver disease chemistry.chemical_compound 0302 clinical medicine Ductopenia All institutes and research themes of the Radboud University Medical Center Fibrosis Internal medicine medicine Humans Hepatitis Hepatology medicine.diagnostic_test business.industry Liver Cirrhosis Biliary Liver Diseases Ursodeoxycholic Acid Obeticholic acid medicine.disease Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] Quartile chemistry 030220 oncology & carcinogenesis Liver biopsy 030211 gastroenterology & hepatology business |
| Zdroj: | Clinical Gastroenterology and Hepatology, 18, 1170-1178.e6 Clinical Gastroenterology and Hepatology, 18, 5, pp. 1170-1178.e6 |
| ISSN: | 1542-3565 |
| DOI: | 10.1016/j.cgh.2019.09.050 |
| Popis: | Background & Aims Primary biliary cholangitis (PBC) is an autoimmune disease characterized by bile duct destruction that can progress to cirrhosis. A liver biopsy substudy was conducted in the PBC obeticholic acid (OCA) International Study of Efficacy (POISE) to determine the long-term effects of OCA on liver damage and fibrosis in patients with PBC. POISE is a phase 3, double-blind, placebo-controlled, randomized trial with a 5-year open-label extension that evaluated 5 to 10 mg OCA daily in patients who were intolerant or unresponsive to ursodeoxycholic acid. Methods Liver biopsy specimens were collected from 17 patients at time of enrollment in the double-blind phase and after 3 years of OCA treatment. Histologic evaluations were performed by 2 pathologists in a blinded, randomized fashion to determine the effects of OCA on fibrosis and other histologic parameters. Collagen morphometry assessments were performed by automated second harmonic generation and 2-photon excitation microscopy to observe quantitative measures of fibrosis. Results From the time of enrollment until 3 years of treatment, most patients had improvements or stabilization in fibrosis (71%), bile duct loss (76%), ductopenia (82%), ductular reaction (82%), interface hepatitis (100%), and lobular hepatitis (94%). Over the 3-year period, we found significant reductions in collagen area ratio (median, –2.1; first quartile, –4.6, third quartile, –0.3; P = .013), collagen fiber density (median, –0.8; first quartile, –2.5; third quartile, 0; P = .021), collagen reticulation index (median, –0.1; first quartile, –0.3; third quartile, 0; P = .008), and fibrosis composite score (median, –1.0; first quartile, –2.5; third quartile, –0.5; P = .002). Conclusions A subanalysis of data from the POISE study showed that long-term OCA treatment in patients with PBC is associated with improvements or stabilization of disease features, including ductular injury, fibrosis, and collagen morphometry features ( ClinicalTrials.gov no: NCT01473524 and EudraCT no: 2011-004728-36). |
| Databáze: | OpenAIRE |
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