This article is more than 5 years old. Information may no longer be current.

UDCA/immunosuppression effectively treated patients with cirrhosis, autoimmune hepatitis

Patients with primary biliary cirrhosis and autoimmune hepatitis treated with ursodeoxycholic acid and immunosuppression responded positively to treatment compared with those who received ursodeoxycholic acid monotherapy in a recent study.

Eighty-eight patients (mean age, 48 years; 84% women) from medical centers throughout the US, Turkey, France, Sweden and Italy were included in the cohort. Patients were assigned 13 mg/kg to 15 mg/kg ursodeoxycholic acid (UDCA; n=30) daily or UDCA and immunosuppression (30 mg to 60 mg prednisone alone or in combination with 50 mg to 150 mg azathioprine; n=58) daily. Patients were followed for a mean of 66 months.

Data showed that 37% of patients who received UDCA monotherapy did not respond to treatment, while UDCA and immunosuppression was effective in 73% of treatment-naive patients or those who were nonresponsive to UDCA. Fifty-four percent of patients who did not respond to the initial immunosuppression responded to second-line immunosuppression (cyclosporine, tacrolimus and mycophenolate mofetil).

Eighty-five percent of the cohort experienced biochemical remission; 19 received UDCA alone, 49 received UDCA with immunosuppression, and seven received second-line immunosuppression. Analysis revealed severe interface hepatitis to be an independent predictor among patients who were nonresponsive to UDCA monotherapy (OR=0.05; 95% CI; 0.004-0.68). Five patients, three with liver-related complications, died, and four patients with primary biliary cirrhosis-autoimmune hepatitis underwent liver transplantation during follow-up.

“Patients with severe interface hepatitis are associated with poor response to UDCA monotherapy and more frequently require additional immunosuppression to achieve biochemical remission,” the researchers wrote. “Second-line immunosuppressive agents can be used in patients who do not respond to conventional immunosuppression.”

Disclosure: The researchers report no relevant financial disclosures.