Clinicians lack knowledge on follow-up of UDCA therapy for primary biliary cirrhosis

A number of clinicians throughout the United Kingdom reported treating patients with primary biliary cirrhosis or cholangitis with ursodeoxycholic acid; however, many reported a lack of follow-up to determine treatment response, according to data presented at the British Society of Gastroenterology Annual Meeting.

Gideon Hirschfield, MA, MB, PhD, of the Institute of Biomedical Research at the University of Birmingham, U.K., and colleagues created and distributed an online survey of clinical practice to all clinicians via mailing list and newsletters, to determine how well clinicians understood primary biliary cirrhosis or primary biliary cholangitis and whether or not they know how to properly treat with ursodeoxycholic acid (UDCA). The questions in the survey focused on diagnosis, management and UDCA response assessment.

Gideon Hirschfield

Researchers received 206 responses to the surveys from the following clinical backgrounds: consultant in a tertiary hospital (n = 14), consultant hepatologists in nontertiary centers (n = 32), consultant gastroenterologists (n = 75), trainees (n = 78) and other specialist nurses (n = 7). Ninety percent reported they routinely used UDCA in clinical practice. However, only 20% reported they assessed UDCA response after a patient received the therapy for 1 year and 50% never assessed treatment response to UDCA.

For response assessment between specialists, 64% of gastroenterologists and 47% of trainees reported they never assessed response compared with 25% of non-tertiary hepatologists and 14% of tertiary hepatologists. The researchers noted that the number of patients each specialist saw affected the rate of UDCA response assessment.

“[Sixty-four percent] of those who saw fewer than 10 patients per year never assessed response compared to 10% of those who saw more than 50 patients per year,” the researchers wrote.

In addition, many clinicians reported not feeling confident to assess response (40%) and others reported not knowing criteria for proper assessment (58%) and unsure of the best criteria used to conduct an assessment (27%).

The researchers concluded: “The majority of patients with PBC are managed by non-specialists outside of tertiary centers many of whom see low volumes of patients with this condition. … Our results demonstrate gaps in knowledge and confidence amongst non-specialists. Implementing a stratified approach to management requires these gaps to be addressed.” – by Melinda Stevens

Reference:

Corrigan M, et al. Abstract #PTH-103. Presented at: British Society of Gastroenterology Annual Meeting; June 20-23, 2016; Liverpool, U.K.

Disclosure: The researchers report no relevant financial disclosures.