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Outcomes better in primary biliary cirrhosis patients who responded to ursodeoxycholic acid

Patients with primary biliary cirrhosis who responded to ursodeoxycholic acid with an increased aspartate transaminase/platelet ratio index at 1 year faced poorer outcomes than biochemical responders with a lower index in a recent study.

Researchers evaluated data from patients with primary biliary cirrhosis (PBC) treated at the Liver Unit in Birmingham, UK (n=386), at the Toronto Center for Liver Diseases (n=479) and at Jena University Hospital in Germany (n=150). Patients in Birmingham were considered the derivation cohort; the validation cohort comprised the other patients.

 

Palak Trivedi

All patients’ baseline aspartate transaminase (AST)/platelet ratio indices (APRIs) were calculated at diagnosis and at 1 year later. APRI (HR=1.95; 95% CI, 1.5-2.54), along with age (HR=1.06; 95% CI, 1.03-1.08), elevated bilirubin levels (HR=1.27; 95% CI, 1.17-1.38) and early-onset cirrhosis (HR=2.4; 95% CI, 1.49-3.86) were independently associated with liver transplantation or death in multivariate analysis of the derivation cohort.

Patients in the derivation cohort who did not respond biochemically to ursodeoxycholic acid (UDCA) at 1 year were more likely to exhibit poorer transplant-free survival. This applied to nonresponders among both cohorts at 1 year (P<.01) compared with responders (P<.001). Age (HR=1.02; 95% CI, 1.01-1.04) and 1 year APRI (HR=1.15; 95% CI, 1.08-1.22) also were associated with death and liver transplantation.

In both cohorts, patients who responded to UDCA with an APRI of more than 0.54 at 1 year exhibited poorer transplant-free survival (P<.01) than biochemical responders with a low APRI (≤0.54; P<.001).

According to the researchers, their study demonstrated “that APRI at diagnosis, and/or after 1 year, is able to independently predict adverse events in patients with [PBC], even when adjusting for treatment exposure and UDCA-response.”

The researchers suggested that clinicians would benefit from the availability of better stratification tools in their clinical practices.

Disclosure: The researchers report no relevant financial disclosures.