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Ursodeoxycholic Acid Response Is Associated With Reduced Mortality in Primary Biliary Cholangitis With Compensated Cirrhosis
Am J Gastroenterol. 2021 May 13. doi: 10.14309/ajg.0000000000001280. Online ahead of print.
Binu V John1, Nidah S Khakoo, Kaley B Schwartz, Gabriella Aitchenson, Cynthia Levy, Bassam Dahman, Yangyang Deng, David S Goldberg, Paul Martin, David E Kaplan, Tamar H Taddei
1Division of Hepatology, Bruce W Carter VA Medical Center, Miami, Florida, USA; Department of Medicine, Jackson Memorial Hospital, Miami, Florida, USA; Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Gastroenterology and Hepatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA; Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA; Division of Gastroenterology and Hepatology, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Introduction: Patients with cirrhosis and men have been under-represented in most studies examining the clinical benefit of response to ursodeoxycholic acid (UDCA) in primary biliary cholangitis (PBC). The aim of this study was to study the association of UDCA response and liver-related death or transplantation, hepatic decompensation, and hepatocellular carcinoma (HCC) in patients with PBC cirrhosis.
Methods: We conducted a retrospective cohort study of veterans, predominantly men, with PBC and compensated cirrhosis to assess the association of UDCA response with the development of all-cause and liver-related mortality or transplantation, hepatic decompensation, and HCC using competing risk time-updating Cox proportional hazards models.
Results: We identified 501 subjects with PBC and compensated cirrhosis, including 287 UDCA responders (1,692.8 patient-years [PY] of follow-up) and 214 partial responders (838.9 PY of follow-up). The unadjusted rates of hepatic decompensation (3.8 vs 7.9 per 100 PY, P < 0.0001) and liver-related death or transplantation (3.7 vs 6.2 per 100 PY, P < 0.0001) were lower in UDCA responders compared with partial responders. UDCA response was associated with a lower risk of hepatic decompensation (subhazard ratio [sHR] 0.54, 95% confidence interval [CI] 0.31-0.95, P = 0.03), death from any cause or transplantation (adjusted hazard ratio 0.49, 95% CI 0.33-0.72, P = 0.0002), and liver-related death or transplantation (sHR 0.40, 95% CI 0.24-0.67, P = 0.0004), but not HCC (sHR 0.39, 95% CI 0.60-2.55, P = 0.32). In a sensitivity analysis, the presence of portal hypertension was associated with the highest UDCA-associated effect.
Discussion: UDCA response is associated with a reduction in decompensation, all-cause, and liver-related death or transplantation in a cohort of predominantly male patients with cirrhosis, with the highest benefit in patients with portal hypertension.