Clinical

Only some patients with biliary cirrhosis respond to UDCA

Last Updated: 2008-12-24 13:27:31 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Among patients with primary biliary cirrhosis treated with ursodeoxycholic acid (UDCA), the change in the portohepatic gradient (PHG) is one indicator that they are likely to respond over the long term, according to French and Canadian researchers.

"In primary biliary cirrhosis patients," lead investigator Dr. Pierre-Michel Huet told Reuters Health, "in addition to the well-known effects on biological parameters, UDCA treatment is associated with a stabilization or improvement of portal hypertension, but this effect is not observed in all patients."

"'Responders' and 'non-responders' can be identified according to changes in PHG and aspartate aminotransferase levels observed 2 years after therapy and have significantly different long-term survivals," he added.

As reported in the November issue of Gastroenterology, Dr. Huet of Hopital L'Archet 2, Nice and colleagues followed 132 patients with primary biliary cirrhosis for up to 15 years. About 35% of this group had a PHG indicative of portal hypertension.

After 2 years of treatment, stable or decreased PHG was predictive of improved survival (hazard ratio, 4.64). This was also true of normalization of aspartate aminotransferase levels (hazard ratio, 2.89).

In fact, say the investigators, at 15 years "in patients considered responders to UDCA, the life expectancy was comparable to that observed for an age-matched population in Quebec."

Given these results, "in non-responders, UDCA use alone is questionable," Dr. Huet pointed out. "These findings are of interest when considering the emerging non-invasive methods aimed at evaluating liver fibrosis, particularly elastography that may prove useful in the indirect assessment of portal hypertension in the near future, therefore avoiding the need for the invasive measurement of the PHG."

Gastroenterology 2008;135:1552-1560.