Biochemical criteria at 1 year are not robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis: results from a 29-year cohort study

Autor:	V, Papastergiou, E A, Tsochatzis, M, Rodriguez-Peralvarez, M, Rodriquez-Peralvarez, E, Thalassinos, G, Pieri, P, Manousou, G, Germani, C, Rigamonti, V, Arvaniti, S, Karatapanis, A K, Burroughs
Rok vydání:	2013
Předmět:	Adult Male medicine.medical_specialty Cholagogues and Choleretics Gastroenterology Severity of Illness Index Cohort Studies Primary biliary cirrhosis Internal medicine Albumins medicine Humans Pharmacology (medical) Aspartate Aminotransferases Aged Hepatology business.industry Liver Cirrhosis Biliary Early disease Ursodeoxycholic Acid Bilirubin Middle Aged medicine.disease Alkaline Phosphatase Prognosis digestive system diseases Ursodeoxycholic acid Natural history Treatment Outcome Immunology Female business medicine.drug Cohort study Follow-Up Studies
Zdroj:	Alimentary pharmacologytherapeutics. 38(11-12)
ISSN:	1365-2036
Popis:	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.To determine whether evaluation of biochemical criteria at 1 year is a reliable surrogate of UDCA response in early PBC.We analysed the prospectively collected data of 215 patients (untreated = 129; UDCA-treated = 86) with early PBC (normal baseline bilirubin/albumin) and a median follow-up of 8 years (range: 1-29.1). The 1-year attainment rates of the Barcelona, Paris-I, Paris-II and Toronto definitions, and their predictive relevance for a poor outcome (death, transplantation, complications of cirrhosis), were assessed either as a result of UDCA or no treatment. Independent associations with attaining each UDCA response definition were identified by multivariate analysis.Untreated patients displayed 1-year biochemical features compatible with 'treatment response' at rates (Barcelona: 36.4%, Paris-I: 66.7%, Toronto: 59.7%, Paris-II: 40.3%) similar to those obtained under UDCA. Depending on the definition, baseline ALP≤3xULN (OR: 4.80-35.90), AST≤2xULN (OR: 5.63-9.34) and early histological stage (OR: 3.67-3.87) were the stronger predictors for attaining the criteria. UDCA treatment was associated with attaining Barcelona (OR = 2.16) and Paris-II (OR = 2.84), but not Paris-I, and not Toronto definition when excluding late histological cases. Paris-I criteria were significantly predictive of long-term outcomes (HR = 2.83) in untreated patients.In early PBC, biochemical criteria at 1 year reflect severity of the disease rather than the therapeutic response to UDCA.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::68b4a891405d73ead36f3d65b0539d9d https://pubmed.ncbi.nlm.nih.gov/24330248 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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