Prospective evaluation of ursodeoxycholic acid withdrawal in patients with primary sclerosing cholangitis

• DOI: 10.1002/hep.27074
• Publication Date: 2014-02-12T13:25:14Z
• Authors: Ewa Wunsch; Jocelyn Trottier; Malgorzata Milkie...; Joanna Raszeja-Wy...; Gideon M. Hirschf...; Olivier Barbier; Piotr Milkiewicz
• Keywords: Ursodeoxycholic acid; Primary Sclerosing Cholangitis; Primary (astronomy)

Ursodeoxycholic acid (UDCA) is no longer recommended for management of adult patients with primary sclerosing cholangitis (PSC). We undertook a prospective evaluation UDCA withdrawal in group consecutive PSC. Twenty six patients, all treated (dose range: 10-15 mg/kg/day) were included. Paired blood samples liver biochemistry, bile acids, and fibroblast growth factor 19 (FGF19) collected before 3 months later. Liquid chromatography/tandem mass spectrometry was used quantification 29 plasma metabolites. Pruritus health-related quality life (HRQoL) assessed 10-point numeric rating scale, the Medical Outcomes Study Short Form-36 (SF-36), PBC-40 questionnaires. resulted significant deterioration biochemistry (increase alkaline phosphatase 75.6%; P<0.0001; gamma-glutamyl transpeptidase 117.9%, bilirubin 50.0%, P<0.001; alanine aminotransferase 63.9%, P<0.005; aspartate 45.0%, P<0.005) increase Mayo Risk Score PSC (change from baseline +0.5 point; P<0.003). Bile analysis revealed decrease lithocholic its derivatives after withdrawal, but effect on concentrations acids aside an increased accumulation their taurine conjugates. After removal cholestatic parameters, species cholic chenodeoxycholic correlated serum FGF19 levels. No HRQoL observed; however, 42% reported pruritus. At months, discontinuation causes influences A proportion report pruritus, other short-term markers are unaffected.