The long-term effect of ursodeoxycholic acid on laboratory liver parameters in biochemically non-advanced primary biliary cirrhosis - 31/01/11

Doi : 10.1016/j.gcb.2010.07.018

E.M.M. Kuiper ^a, B.E. Hansen ^a,^b, W. Lesterhuis ^c, R.J. Robijn ^d, J.C. Thijs ^e, L.G.J.B. Engels ^f, G.H. Koek ^g, M.N. Aparicio ^h, M.J. Kerbert-Dreteler ⁱ, H.R. van Buuren ^a,^⁎
for the Dutch PBC study group
^a Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
^b Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
^c Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
^d Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
^e Department of Internal Medicine, Bethesda Hospital, Hoogeveen,The Netherlands
^f Department of Gastroenterology and Hepatology, Orbis Medical Center, Sittard, The Netherlands
^g Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
^h Department of Gastroenterology and Hepatology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
ⁱ Department of Internal Medicine, Medical Spectrum Twente, Enschede, The Netherlands

Corresponding author. Erasmus Medical Center Rotterdam, Department of Gastroenterology and Hepatology, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

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Summary

Background and aims

Ursodeoxycholic acid (UDCA) has an established effect on liver biochemistries in primary biliary cirrhosis (PBC). Few studies have evaluated long-term laboratory treatment effects and data beyond 6 years are not available. The aim of this study was to assess the long-term evolution of liver biochemistries during prolonged treatment with UDCA in biochemically non-advanced PBC.

Patients and methods

Prospective multicenter cohort study of patients with PBC with pretreatment normal bilirubin and albumin, treated with UDCA 13–15mg/kg/day. At yearly intervals, follow-up data including serum bilirubin, alkaline phosphatase (ALP), transaminases, albumin and IgM were collected. Data were analyzed with a repeated measurement model.

Results

Two hundred and twenty-five patients were included and followed during a median period of 10.3 years. Following 1-year treatment with UDCA 36–100% of the total biochemical improvement was achieved, the maximum response was observed after 3 years. After initial improvements, bilirubin and AST levels increased and albumin levels significantly decreased after 6–10 years. However, these changes were of limited magnitude. The beneficial effects on ALT and ALP were maintained while IgM continued to decrease.

Conclusion

In non-advanced PBC the biochemical response to UDCA is maintained up to 15 years. The long-term evolution of bilirubin, albumin and ALT differs from that of ALP and AST. The mean IgM level normalised and levels continued to decrease during the period of follow-up.

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Abbreviations : UDCA, PBC, ALP, ALT, AST, AMA