Colchicine for Primary Biliary Cirrhosis: A Cochrane Hepato-Biliary Group Systematic Review of Randomized Clinical Trials

Yang, Gong; Gluud, Christian

doi:10.1111/j.1572-0241.2005.41522.x

Cited by 39 publications

(13 citation statements)

References 35 publications

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“…A systematic review of 10 trials involving 631 patients found no significant benefit on mortality, the need for liver transplantation, or improvement in liver biochemical tests or histology. 70 However, colchicine may improve pruritus.…”

Section: Other Specific Treatments Used Alone or In Combination With mentioning

confidence: 99%

Old and Novel Therapies for Primary Biliary Cirrhosis

Parés

2014

Semin Liver Dis

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Despite the presumed immunological pathogenesis of primary biliary cirrhosis, no clear or even harmful consequences resulted from some specific treatments addressed to modify the immunological condition. However, ursodeoxycholic acid (UDCA; 13-16 mg/kg/d) has clear favorable effects not only by improving biochemical cholestasis, but also by delaying the histological progression. Long -term treatment with UDCA is associated with excellent survival, free of transplantation in cases showing biochemical response at one year. In the remaining patients, data on the effect of fibrates, budesonide, or obeticholic acid are encouraging. Pruritus is usually managed using resins; further steps are needed in resistant cases with the use of rifampicin, naltrexone, sertraline, or invasive procedures such as albumin dialysis. Osteoporosis, which is highly prevalent in patients with deep and prolonged cholestasis, improves with bisphosphonates; current data indicate that both weekly alendronate and monthly ibandronate increase bone mass in patients with osteoporosis. Nutritional and fat-vitamin supplementation is also mandatory in patients with severe cholestasis.

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Section: Other Specific Treatments Used Alone or In Combination With mentioning

confidence: 99%

Old and Novel Therapies for Primary Biliary Cirrhosis

Parés

2014

Semin Liver Dis

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“…Several drugs such as corticosteroids,56,57 azathioprine,58–60 cyclosporine,61,62 methotrexate,63–65 penicillamine,66 colchicines,67,68 and other agents such as malotilate,69 chlorambucil,70 and thalidomide71 have been evaluated. However, a clear benefit from immunosuppressive agents has not been demonstrated to date.…”

Section: Natural History In the Udca Eramentioning

confidence: 99%

Natural history and management of primary biliary cirrhosis

Al-Harthy¹,

Kumagi²

2012

HMER

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Primary biliary cirrhosis (PBC) is a chronic inflammatory autoimmune disease that mainly targets the cholangiocytes of the interlobular bile ducts in the liver. It is a rare disease with prevalence of less than one in 2000. Its prevalence in developing countries is increasing presumably because of growth in recognition and knowledge of the disease. PBC is thought to result from a combination of multiple genetic factors and superimposed environmental triggers. The contribution of the genetic predisposition is evidenced by familial clustering. Several risk factors, including exposure to infectious agents and chemical xenobiotics, have been suggested. Common symptoms of the disease are fatigue and pruritus, but most patients are asymptomatic at first presentation. The prognosis of PBC has improved because of early diagnosis and use of ursodeoxycholic acid, the only established medical treatment for this disorder. When administered at adequate doses of 13–15 mg/kg/day, up to two out of three patients with PBC may have a normal life expectancy without additional therapeutic measures. However, some patients do not respond adequately to ursodeoxycholic acid and might need alternative therapeutic approaches.

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“…A potential benefit of methotrexate plus UDCA in patients with earlystage has been suggested, but no effects on mortality or the decrease in the need for liver transplantation have been demonstrated [56] . Some data on the effect of colchicine were interesting [57] , but the long-term studies were not as optimistic. Cyclosporine does not appear to either increase the survival or prevent the complications of PBC [58] .…”

Section: Therapies With Minor Favourable or Controversial Effectsmentioning

confidence: 99%

Therapy of Primary Biliary Cirrhosis: Novel Approaches for Patients with Suboptimal Response to Ursodeoxycholic Acid

Parés¹

2015

Dig Dis

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Primary biliary cirrhosis (PBC) is a chronic cholestatic disease of presumed autoimmune pathogenesis, characterized by the inflammation and damage of the intrahepatic intermediate and small bile ducts, which eventually results in cirrhosis. A number of randomized and observational and pilot studies using several agents were carried out in the 80s, but no clear results or even harmful effects were reported. Over the past 2 decades, increasing evidence indicates that ursodeoxycholic acid (UDCA) - 13 to 16 mg/kg/day - is the treatment of choice for patients with PBC. Biochemical response to UDCA, assessed at 1 year, clearly predicts the long-term outcome, since in UDCA, responders survival is similar to that estimated for the matched control population. However, about 40% of patients have incomplete biochemical response and increased risk of progression and decreased survival free of transplantation. Patients with suboptimal biochemical response to UDCA outline the group in whom further single or combined treatments with UDCA are needed. Accordingly, data on the effect of fibrates alone or in combination with UDCA, and budesonide in combination with UDCA have been reported. The combined treatment of UDCA and fibrates in patients without optimal biochemical response to UDCA improves the degree of cholestasis and may minimize the long-term management of these patients. The results of the combined therapy of UDCA with budesonide are appealing but they should be established in large randomized trials. The effect of new agents such obeticholic acid are promising, since the addition of this farnesoide-X-receptor agonist bile acid in patients with stable UDCA dosage and increased alkaline phosphatase levels results in an improvement of cholestasis as compared to placebo, with a parallel decrease of aminotransferases and immunoglobulin M, as well as one surrogate marker of bile acid synthesis. New molecular therapies are currently being investigated.

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Colchicine for Primary Biliary Cirrhosis: A Cochrane Hepato-Biliary Group Systematic Review of Randomized Clinical Trials

Cited by 39 publications

References 35 publications

Old and Novel Therapies for Primary Biliary Cirrhosis

Old and Novel Therapies for Primary Biliary Cirrhosis

Natural history and management of primary biliary cirrhosis

Therapy of Primary Biliary Cirrhosis: Novel Approaches for Patients with Suboptimal Response to Ursodeoxycholic Acid

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