Improved prognosis of PBC w biochemical response to urso

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Gastroenterology [in Press] (2009)

Improved prognosis of patients with Primary Biliary Cirrhosis that

have a biochemical response to ursodeoxycholic acid.

Edith M.M. Kuiper1, Bettina E. Hansen12, A. de Vries3, Jannie

W. den Ouden-Muller4, Theo J.M. van Ditzhuijsen5, Els B. Haagsma6,

H.M.G. Houben7, Ben J.M. Witteman8, Karel J. van Erpecum9,

Henk R. van Buuren1, for the Dutch PBC study group

Background and Aims

Ursodeoxycholic Acid (UDCA) improves laboratory liver tests in

patients with Primary Biliary Cirrhosis (PBC). Few studies have

assessed prognostic significance of biochemical data collected

following UDCA treatment. We performed a prospective, multicenter

study of PBC patients treated with UDCA to compare prognosis with

biochemical response.

Methods

PBC was classified as early (pre-treatment bilirubin and albumin

levels normal), moderately advanced (one abnormal) or advanced (both

abnormal). Biochemical response was defined as proposed by Pares

(decrease in alkaline phosphatase [ALP] levels >40% of baseline or

normal levels), Corpechot (CO: ALP<3-fold the upper limit of normal

[uLN]; aspartate aminotransferase levels <2-fold the ULN, bilirubin<1-

fold the ULN) and our group (RD: normalization of abnormal bilirubin

and/or albumin).

Results

The study included 375 patients and median follow-up time was 9.7

(1.0-17.3) years. The prognosis for early PBC was comparable with

that of the Dutch population and better than predicted by Mayo risk

score. Survival of responders was better than of non-responders,

according to CO and RD criteria (p<0.001). Prognosis of early PBC was

comparable for responders and non-responders; prognosis of responders

was significantly better in those with(moderately) advanced disease.

Conclusions

Prognosis for UDCA-treated patients with early PBC is comparable to

that of the general population. Survival of those with advanced PBC

with biochemical response to UDCA is significantly better than for

non-responders. Thus, UDCA may be of benefit irrespective of the

stage of disease. Prognostic information, based on bilirubin and

albumin levels, is superior to that provided by ALP levels.

Keywords: Primary Biliary Cirrhosis, PBC, UDCA, prognosis,

biochemical response

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I'd really like to see this kind of analysis done with PSC!

Dave

(father of (23); PSC 07/03; UC 08/03)