Ursodeoxycholic acid therapy for primary sclerosing cholangitis: results of a 2-year randomized controlled trial to evaluate single versus multiple daily doses
| Autor: | J. M. J. I. Salemans, Hillechien Kuiper, Aad C. Hoek, T. Gie Tan, F. H. J. Wolfhagen, Marco C.M. Rijk, Gerard A.J.J. Nix, Marco C. Becx, Henk R. van Buuren, Joost Scherpenisse, Paul H.G.M. Stadhouders, Dennis P.F. van Houte, Paul C. van de Meeberg, Max Schrijver, Adelbert M. Smit, Gerard P. vanBerge-Henegouwen, Wim C. J. Hop, Hubert J. F. van Hoogstraten, Solko W. Schalm, Pieter Spoelstra, Fiebo J.W. ten Kate |
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| Přispěvatelé: | Other departments, Internal Medicine, Radiology & Nuclear Medicine, Epidemiology, Pathology |
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male medicine.medical_specialty Cholagogues and Choleretics Bilirubin medicine.medical_treatment Cholangitis Sclerosing Liver transplantation Gastroenterology Drug Administration Schedule Primary sclerosing cholangitis law.invention chemistry.chemical_compound Randomized controlled trial law Internal medicine Ascites medicine Humans Treatment Failure Survival rate Netherlands Chemotherapy Hepatology Dose-Response Relationship Drug business.industry Ursodeoxycholic Acid Middle Aged medicine.disease Ursodeoxycholic acid Survival Rate chemistry Evaluation Studies as Topic Female medicine.symptom business medicine.drug |
| Zdroj: | Journal of hepatology, 29(3), 417-423. Elsevier Journal of Hepatology, 29, 417-423. Elsevier |
| ISSN: | 1600-0641 0168-8278 |
| Popis: | Background/Aims: Ursodeoxycholic acid has been reported to be of potential benefit for primary sclerosing cholangitis but little is known about the long-term biochemical, histological and radiological efficacy or the optimum frequency of ursodeoxycholic acid administration. Methods: A 2-year multicentre randomised controlled trial was initiated to assess the effects of ursodeoxycholic acid (10 mg · kg −1 · d − ), given in either single or multiple daily doses, on symptoms, serum liver tests, cholangiographic and histological findings and the occurrence of treatment failure. Liver biopsies were taken and endoscopic retrograde cholangiography was performed at entry and after 2 years; follow-up examinations were at 3-month intervals. Treatment failure was defined as death, liver transplantation, 4-fold increase in serum bilirubin, variceal bleeding, de novo ascites or cholangitis. Actuarial survival was compared with predicted survival using the revised Mayo natural history model for primary sclerosing cholangitis. Results: Forty-eight patients were enrolled. In one case, ursodeoxycholic acid had to be discontinued because of gastro-intestinal complaints. No other side-effects were observed. Afte 2 years of follow-up, treatment was not associated with a beneficial effect on either symptoms or liver histology. Serum liver tests (alkaline phosphate, γ-glutamyl transferase, aspartate aminotransferase) improved significantly in both groups, while serum bilirubin (which was near normal at entry) and IgG remained stable. No major changes in radiographic bile duct appearance seemed to be present. After 2 years, actuarial survival was 91% (95 CI 83%–99%), which is comparable to the predicted 97% survival rate. Treatment failure occurred in 15% of cases. No significant differences in any of the study endpoints (symptoms, serum liver tests, cholangiographic findings, histology, disease progression) were found between the two groups. Conclusions: Ursodeoxycholic acid is well obtained in primary sclerosing cholangitis. Significant effects on biochemical parameters were found and symptoms, bilirubin and histology did not deteriorate. No advantage of a multiple daily dose over a single dose was observed. |
| Databáze: | OpenAIRE |
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