Bile acids for primary sclerosing cholangitis

Abstract

BackgroundPrimary sclerosing cholangitis is a progressive chronic cholestatic liver disease that usually leads to the development of cirrhosis. Studies evaluating bile acids in the treatment of primary sclerosing cholangitis have shown a potential benefit of their use. However, no influence on patients survival and disease outcome has yet been proven. ObjectivesTo assess the beneficial and harmful e ects of bile acids for patients with primary sclerosing cholangitis. Search methodsWe searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Library, MEDLINE, EMBASE and Science Citation Index Expanded generally from inception through to October 2010. Selection criteriaRandomised clinical trials comparing any dose of bile acids or duration of treatment versus placebo, no intervention, or another intervention were included irrespective of blinding, language, or publication status. Data collection and analysisTwo authors extracted data independently. We evaluated the risk of bias of the trials using prespecified domains. We performed the metaanalysis according to the intention-to-treat principle. We presented outcomes as relative risks (RR) or mean di erences (MD), both with 95% confidence intervals (CI). Main resultsEight trials evaluated ursodeoxycholic acid versus placebo or no intervention (592 patients). The eight randomised clinical trials have a high risk of bias. Patients were treated for three months to six years (median three years). The dosage of ursodeoxycholic acid used in the trials ranged from low (10 mg/kg body weight/day) to high (28 to 30 mg/kg body weight/day). Ursodeoxycholic acid did not significantly reduce the risk of death (RR 1.00; 95% CI 0.46 to 2.20); treatment failure including liver transplantation, varices, ascites, and encephalopathy (RR 1.22; 95% CI 0.91 to 1.64); liver histological deterioration (RR 0.89; 95% CI 0.45 to 1.74); or liver cholangiographic deterioration (RR 0.60; 95% CI 0.23 to 1.57). Ursodeoxycholic acid significantly improved serum bilirubin (MD -14.6 µmol/litre; 95% CI -18.7 to -10.6), alkaline phosphatases (MD -506 IU/litre; 95% CI -583 to -430), aspartate aminotransferase (MD -46 IU/litre; 95% CI -77 to -16), and gamma-glutamyltranspeptidase (MD -260 IU/litre; 95% CI -315 to -205), but not albumin (MD -0.20 g/litre; 95% CI -1.91 to 1.50). Ursodeoxycholic acid was safe and well tolerated by patients with primary sclerosing cholangitis.Bile acids for primary sclerosing cholangitis (Review)

A Case of Rapidly Progressive Primary Sclerosing Cholangitis Requiring Liver Transplantation

“…However, in PSC, the effectiveness of these endoscopic procedures is still unclear because there have been no randomized controlled studies to report on the benefits (9). Some studies have reported that UDCA improved liver function, but they failed to demonstrate if it halted PSC progression (14)(15)(16). Furthermore, recent studies revealed that high-dose UDCA (28∼30 mg/kg/day) did not improve patient survival and was associated with severe adverse effects (17,18).…”

A review of liver disorders in inflammatory bowel disease (IBD)

“…Higher doses of UCDA (20-30 mg/kg/day) have been shown to be detrimental, rather than to have any substantial clinical benefit [72][73][74][75][76]. UCDA does not improve liver histology or liver transplant free survival, nor does it prevent the development of cholangiocarcinoma, colonic adenomas, colon cancer or incidence of death [73,[77][78][79]. Corticosteroids have not been proven effective either as single agents or when used with colchicine or ursodeoxycholic acid [80], nor have methotrexate, colchicine, pentoxifylline, etanercept, or mycophenolate mofetil proved useful in PSC [81][82][83][84][85][86].…”

Riječka Cochrane grupa – prikaz aktivnosti i rezultata

“…Unatoč vrlo ograničenim dokazima za bilo kakvu učinkovitost navedene terapiju u pacijentica s PBC-om, utvrđeno je da značajno veći broj ispitanika prekida navedenu terapiju zbog nuspojava (RR 5,26; 95 % CI 1,26 do 22,04). 11,12 Naša je skupina autora objavila dva Cochrane sustavna pregleda na temu primarnog sklerozirajućeg kolangitisa. U prvom je analizirana primjena glukokortikoida, dok su u drugom obuhvaćene studije primjene žučnih kiselina kao terapijske opcije.…”