Effects of Bezafibrate on Outcome and Pruritus in Primary Biliary Cholangitis With Suboptimal Ursodeoxycholic Acid Response

Autor: Albert Parés, Pilar Sesé, Anna Reig
Rok vydání: 2018
Předmět:
Male
Cholagogues and Choleretics
medicine.medical_specialty
Carcinoma
Hepatocellular
Visual Analog Scale
medicine.medical_treatment
Jaundice
Liver transplantation
Gastroenterology
03 medical and health sciences
Alkaline phosphatase blood
0302 clinical medicine
Pharmacotherapy
Internal medicine
medicine
Humans
skin and connective tissue diseases
Hypolipidemic Agents
Bezafibrate
integumentary system
Hepatology
Liver Cirrhosis
Biliary
business.industry
Pruritus
Liver Neoplasms
Ursodeoxycholic Acid
Disease progression
Middle Aged
Alkaline Phosphatase
Prognosis
Ursodeoxycholic acid
Liver Transplantation
body regions
030220 oncology & carcinogenesis
Disease Progression
Elasticity Imaging Techniques
Drug Therapy
Combination
Female
030211 gastroenterology & hepatology
medicine.symptom
business
medicine.drug
Zdroj: American Journal of Gastroenterology. 113:49-55
ISSN: 0002-9270
DOI: 10.1038/ajg.2017.287
Popis: Adding fibrates improves liver biochemistries in patients with primary biliary cholangitis (PBC) and suboptimal response to ursodeoxycholic acid (UDCA). As there are no consistent data regarding the course and outcome, we have assessed the effects of the combined treatment with UDCA and bezafibrate on a long-term basis.A total of 48 patients (45 female) with PBC treated with UDCA and alkaline phosphatase (ALP) above 1.5 times upper normal levels (× UNL) were treated with bezafibrate (400 mg/day) plus UDCA (13-16 mg/kg/day). Changes in clinical features, liver biochemistries, and prognosis after therapy were assessed, as well as pruritus, using a visual analog scale (43 patients) and the 5-D descriptive pruritus scale.After a median of 38 months, 26 patients (54%) had normalized ALP. In these patients, jaundice, pruritus, and liver stiffness was lower, and age was higher than in patients who remained with elevated ALP. Biochemical improvement was less prominent in patients without ALP normalization. Five of these patients (23%) developed events of disease progression: 1 died, 3 were transplanted, and 1 developed hepatocellular carcinoma. Partial or complete itching relief was reported in all but one case with pruritus. Itching recurrence or worsening was observed after bezafibrate discontinuation.The long-term treatment with UDCA and bezafibrate results in excellent response, and is associated with a complete or partial itching relief. Incomplete ALP normalization was observed in patients with advanced disease who remained at risk for developing severe events. The combined treatment is mainly effective in patients with lower fibrosis and severity of cholestasis.
Databáze: OpenAIRE
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