Primary biliary cholangitis: treatment.
Journal
Current opinion in gastroenterology
ISSN: 1531-7056
Titre abrégé: Curr Opin Gastroenterol
Pays: United States
ID NLM: 8506887
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
26
1
2021
medline:
16
10
2021
entrez:
25
1
2021
Statut:
ppublish
Résumé
To discuss the most recent data regarding treatment of patients with primary biliary cholangitis (PBC) with inadequate response to ursodeoxycholic acid (UDCA). Patients with PBC at high-risk of progressive disease are younger, have advanced fibrosis and showed inadequate response to UDCA after 12 months of treatment. These patients need a second-line treatment in addition to UDCA. The goal of therapy should be the normalization of ALP and bilirubin below 0.6 the upper limit of normal. Obeticholic acid (OCA) has proven to be effective in improving surrogate markers of prognosis in PBC, also in real-life cohort. Pruritus is the most frequent adverse event during treatment with OCA. Bezafibrate is another option in patients with inadequate response to UDCA as it was proven to improve surrogate endpoints, pruritus and even, clinical outcome compared with UDCA monotherapy. Finally, budesonide may be considered in patients with marked portal inflammation. Triple therapy with UDCA, OCA and bezafibrate may be considered in patients showing inadequate response to dual therapy. Patients with PBC need to be evaluated at baseline, and on-treatment, for the risk of progressive disease and eventually treated with second-line therapies in addition to UDCA.
Identifiants
pubmed: 33492001
doi: 10.1097/MOG.0000000000000708
pii: 00001574-202103000-00006
doi:
Substances chimiques
Ursodeoxycholic Acid
724L30Y2QR
Bilirubin
RFM9X3LJ49
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
99-104Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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