Academic Journal
Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis
| العنوان: | Ursodeoxycholic acid therapy and liver transplant-free survival in patients with primary biliary cholangitis |
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| المؤلفون: | M. H. Harms, H. R. van Buuren, C. Corpechot, D. Thorburn, H. L. A. Janssen, K. D. Lindor, G. M. Hirschfield, A. Parés, A. Floreani, M. J. Mayo, P. Invernizzi, P. M. Battezzati, F. Nevens, C. Y. Ponsioen, A. L. Mason, K. V. Kowdley, W. J. Lammers, B. E. Hansen, A. J. van der Meer |
| المساهمون: | M.H. Harm, H.R. van Buuren, C. Corpechot, D. Thorburn, H.L.A. Janssen, K.D. Lindor, G.M. Hirschfield, A. Paré, A. Floreani, M.J. Mayo, P. Invernizzi, P.M. Battezzati, F. Neven, C.Y. Ponsioen, A.L. Mason, K.V. Kowdley, W.J. Lammer, B.E. Hansen, A.J. van der Meer |
| بيانات النشر: | Elsevier |
| سنة النشر: | 2019 |
| المجموعة: | The University of Milan: Archivio Istituzionale della Ricerca (AIR) |
| مصطلحات موضوعية: | Treatment, Patient management, Mortality, Cholestasi, UDCA, transplantation, Clinical trials, Settore MED/09 - Medicina Interna, Settore MED/12 - Gastroenterologia |
| الوصف: | Background & Aims: The clinical efficacy of ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC) remains subject to debate as definitive randomized controlled trials are lacking. We aimed to determine whether UDCA prolongs liver transplant (LT)-free survival in patients with PBC. Methods: This international cohort study included patients from the Global PBC Study Group database, originating from 8 countries in Europe and North America. Both UDCA-treated and untreated patients were included. LT and death were assessed as a combined endpoint through Cox regression analyses, with inverse probability treatment weighting (IPTW). Results: In the 3,902 patients included, the mean (SD) age was 54.3 (11.9) years, 3,552 patients (94.0%) were female, 3,529 patients (90.4%) were treated with UDCA and 373 patients (9.6%) were not treated. The median (interquartile range) follow-up was 7.8 (4.1-12.1) years. In total, 721 UDCA-treated patients and 145 untreated patients died or underwent LT. After IPTW, the 10-year cumulative LT-free survival was 79.7% (95% CI 78.1-81.2) among UDCA-treated patients and 60.7% (95% CI 58.2-63.4) among untreated patients (p <0.001). UDCA was associated with a statistically significant reduced risk of LT or death (hazard ratio 0.46, 95% CI 0.40-0.52; p <0.001). The hazard ratio remained statistically significant in all stages of disease. Patients classified as inadequate biochemical responders after 1 year of UDCA had a lower risk of LT or death than patients who were not treated (adjusted hazard ratio 0.56; 95% CI 0.45-0.69; p <0.001). Conclusion: The use of UDCA improves LT-free survival among patients with PBC, regardless of the disease stage and the observed biochemical response. These findings support UDCA as the current universal standard of care in PBC. Lay summary: In this international multicenter study of 3,902 patients with primary biliary cholangitis, we found that treatment with ursodeoxycholic acid is associated with prolonged liver transplant-free survival. ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/30980847; info:eu-repo/semantics/altIdentifier/wos/WOS:000475462500018; volume:71; issue:2; firstpage:357; lastpage:365; numberofpages:9; journal:JOURNAL OF HEPATOLOGY; http://hdl.handle.net/2434/662052; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85066080497 |
| DOI: | 10.1016/j.jhep.2019.04.001 |
| الاتاحة: | http://hdl.handle.net/2434/662052 https://doi.org/10.1016/j.jhep.2019.04.001 |
| Rights: | info:eu-repo/semantics/closedAccess |
| رقم الانضمام: | edsbas.75DBEE23 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1016/j.jhep.2019.04.001 |
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