Effects of ursodeoxycholic acid after 4 to 12 years of therapy in early and late stages of primary biliary cirrhosis

Leuschner, U.; Güldütuna, S.; Imhof, Matthias; Hübner, K.; Benjaminov, Ala; Leuschner, M.

doi:10.1016/s0168-8278(94)80111-8

Cited by 43 publications

(16 citation statements)

References 35 publications

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“…Withdrawal of UDCA induces rebound effects even after many years of treatment, 19 suggesting that UDCA should be recommended as a lifelong therapy. Long-term methotrexate treatment has recently been reported to lead to clinical remission, normalization of liver biochemistries, and improvement in histological stage in a subgroup of 5 patients with PBC.…”

Section: Discussionmentioning

confidence: 99%

Long-term ursodeoxycholic acid delays histological progression in primary biliary cirrhosis

Batts²,

et al. 1999

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Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease frequently leading to development of cirrhosis and its complications. Ursodeoxycholic acid (UDCA) is a beneficial medical therapy for patients with PBC. Improvement in some histological features, but not in histological stage, has been reported after 2 years of UDCA therapy. Thus, longer follow-up may be necessary to determine whether UDCA has a favorable effect on histological stage of disease and progression to cirrhosis. Our aim was to determine the long-term effects of UDCA therapy on histological stage and progression to cirrhosis in patients with PBC. Sixteen unselected patients with noncirrhotic PBC who had been on long-term UDCA therapy (13-15 mg/kg/d) for 6.6 ؎ 0.4 years (range, 5-9 years) were identified and their histological finding during treatment compared with that of 51 noncirrhotic patients with PBC who had received ineffective therapy (D-penicillamine [DPCA] or placebo) for 5.6 ؎ 0.07 years (range, 5-8 years). Histological stage was determined using the Ludwig classification. The rate of progression to cirrhosis (stage 4) was significantly less in the UDCA group than in the control group (13% vs. 49%; P ‫؍‬ .009). Although the overall rate of progression of histological stage was less in the UDCA group than in the control group (50% vs. 71%), this difference was not significant (P ‫؍‬ .1). A marked improvement in liver biochemistries and Mayo risk score was noted in all patients during UDCA therapy; however, this improvement was not significantly different between patients who progressed and those who did not. In conclusion, long-term UDCA therapy appeared to delay the development of cirrhosis in PBC. (HEPATOLOGY 1999;29:644-647.)

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Section: Discussionmentioning

confidence: 99%

Long-term ursodeoxycholic acid delays histological progression in primary biliary cirrhosis

Batts²,

et al. 1999

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“…Long-term treatment with UDCA was reported in 22 patients followed up for up to 12 years. 7 The small number of patients does not allow more than suggestive conclusions.…”

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confidence: 99%

Ten-year survival in ursodeoxycholic acid-treated patients with primary biliary cirrhosis

et al. 1999

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Ursodeoxycholic acid (UDCA) treatment has been shown to increase survival without orthotopic liver transplantation (OLT) in patients with primary biliary cirrhosis (PBC) at 4 years. Whether this beneficial effect was maintained over the long term remained to be established. In a large cohort of UDCA-treated patients with PBC, we aimed to determine the 10-year outcome of these patients using two endpoints: (1) survival without OLT, and (2) survival. The cohort was comprised of 225 patients with PBC treated with UDCA (13-15 mg/kg/d) monitored from the beginning of treatment until time of last follow-up, OLT, or death. Because of the absence of a control group, survival without OLT was compared with survival predicted by the Mayo model (first 7 years), and observed 10-year survival with an estimation of survival of a standardized control cohort of the French population. Observed survival without OLT of UDCAtreated patients was significantly higher (P F .04) than survival predicted by the Mayo model. Observed survival was significantly lower (P F .01) than survival predicted from the French population. Observed survival of noncirrhotic patients was not different (P G .9) from that of the French control population but survival of cirrhotic patients was significantly lower (P F .0001). Twenty-two patients died; 13 patients died of hepatic causes and 4 patients died after OLT. In conclusion, survival without OLT among patients treated with UDCA for PBC is higher than that of untreated patients, as predicted by the Mayo model. Tenyear survival among UDCA-treated patients is slightly lower than that of an age-and sex-matched general population, the difference mainly being explained by mortality among cirrhotic patients. (HEPATOLOGY 1999; 29:1668-1671.)

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“…This effect is especially visible in studies with advanced disease (bilirubin >1.4 mg/dl, and/or histological stage III, IV) [38]. In 1992, patients with PBC treated with UDCA were followed for a maximum of 12 years, and the survival time of these patients exceeded those of previously studied controls [39]. In a recently published long-term trial, the 10-year survival of 225 patients treated with UDCA was higher than that of untreated patients predicted by the Mayo model [40].…”

Section: Treatment Of Pbcmentioning

confidence: 99%

Medical Treatment of Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Holtmeier

Leuschner²

2001

Digestion

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Treatment of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) with ursodeoxycholic acid (UDCA) has been in common use since 1985. In PBC, treatment with UDCA improves laboratory data, liver histology, enables a longer transplantation-free interval and prolongs disease survival. Because UDCA is unable to cure the disease newer drugs or combination therapies are still needed. Studies with UDCA and immunosuppressants such as prednisone, budesonide and azathioprine have shown that in selected patients combination therapy may be superior to UDCA monotherapy. PSC is treated successfully with UDCA and endoscropic dilatation of the bile duct strictures. Treatment of extrahepatic manifestations of cholestatic liver disease such as pruritus, fatigue, osteoporosis and steatorrhea can be problematic and time-consuming.

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Effects of ursodeoxycholic acid after 4 to 12 years of therapy in early and late stages of primary biliary cirrhosis

Cited by 43 publications

References 35 publications

Long-term ursodeoxycholic acid delays histological progression in primary biliary cirrhosis

Long-term ursodeoxycholic acid delays histological progression in primary biliary cirrhosis

Ten-year survival in ursodeoxycholic acid-treated patients with primary biliary cirrhosis

Medical Treatment of Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

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