Treatment of primary biliary cholangitis ursodeoxycholic acid non-responders: A systematic review

Liver International : Official Journal of the International Association for the Study of the Liver
Duminda SuraweeraSammy Saab

Abstract

Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis, is a chronic cholestatic liver disease characterized by an immune mediated destruction of intrahepatic bile ducts. Ursodeoxycholic acid (UDCA) has been the primary medication for the treatment of PBC, resulting in improved liver tests, resolution of symptoms and increased transplant free survival. However, not all patients respond to UDCA. The aim of this systematic review is to provide an evidence based assessment of the medications that have been studied in patients who are refractory to UDCA. We performed a systematic literature search on MEDLINE and the Cochrane Database of Systematic Reviews of the published literature. A total of 23 articles fulfilling our inclusion criteria were found. Several studies have shown an improvement in liver biochemistries with the use of obeticholic acid in conjunction with UDCA. Fibrates, including fenofibrate and bezafibrate, have evidence supporting benefit in this population but need more robust studies to confirm these observational results. Neither obeticholic acid nor fibrates have shown to increase transplant free survival. While there may be some benefit with methotrexate, colchicine, budesonide, mycophen...Continue Reading

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Citations

May 15, 2018·Liver International : Official Journal of the International Association for the Study of the Liver·Jordan Goldstein, Cynthia Levy
Jul 18, 2018·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Mehmet SayinerZobair M Younossi
Aug 28, 2018·Journal of Clinical Gastroenterology·Zobair M YounossiAndrei Racila
Apr 8, 2020·Expert Opinion on Emerging Drugs·Naw April PhawDavid Jones
Oct 6, 2020·Frontiers in Medicine·Mary Stofan, Grace L Guo
Dec 20, 2019·Digestive Diseases and Sciences·Leonard KapsJörn M Schattenberg
Feb 27, 2021·Progress in Lipid Research·Stefano FiorucciMichele Biagioli
Apr 15, 2021·Expert Opinion on Drug Discovery·Stefano FiorucciEleonora Distrutti
Jul 24, 2020·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Yajie CaiRunping Liu

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