Additional fibrate treatment in UDCA‐refractory PBC patients

• DOI: 10.1111/liv.14165
• Publication Date: 2019-06-04T17:16:56Z
• Authors: Sung Won Chung; Jeong‐Hoon Lee; Minseok Albert Kim; Galam Leem; Sun Woong Kim; Young Chang; Hyo Young Lee; Jun Sik Yoon; Jun Yong Park; Yun Bin Lee; Eun Ju Cho; Su Jong Yu; Yoon Jun Kim; Jung‐Hwan Yoon
• Keywords: Fibrate; Ursodeoxycholic acid; Bezafibrate

Abstract Background & Aims There is no proven treatment for ursodeoxycholic acid (UDCA)‐refractory primary biliary cholangitis (PBC) other than obeticholic acid. Although fibrates have been reported to improve biochemical parameters, the long‐term effects remain unclear. This study evaluated effect of fibrate on clinical outcomes UDCA‐refractory PBC. Methods Patients whose alkaline phosphatase (ALP) was not normalized with at least 13 mg/kg UDCA >1 year were included from two tertiary referral centres. The outcome ALP normalization. Secondary development cirrhosis and hepatic deterioration. Immortal time bias adjusted using Mantel‐Byar method. Results A total 100 PBC patients included: 71 received alone (the group) 29 plus additional 160 mg/d fenofibrate or 400 bezafibrate fibrate/UDCA group). During follow‐up period, probability normalization significantly higher in group (hazard ratio [HR] = 5.00, 95% confidence interval 2.87‐8.27, P < 0.001). Among 58 non‐cirrhotic (43 15 group), 19 (44.1%) none developed (HR 0.12, 0.04). Hepatic deterioration (Child‐Pugh score increase signs decompensated cirrhosis) occurred 17 (23.9%) which difference significant Conclusions In PBC, associated a lower risk