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PBC prevalence increasing in US, incidence remains steady

Recently published data showed that prevalence of primary biliary cholangitis increased from 2004 to 2014 in the U.S., but incidence remained steady. Ursodeoxycholic acid treatment correlated significantly with improved mortality rates.

“Our findings suggest improvements in reduced mortality — especially in UDCA-treated patients — as well as earlier diagnosis among PBC patients under routine clinical care in the U.S.,” Mei Lu, PhD, from the Henry Ford Health System, and colleagues wrote. “Given that our sample was drawn from a geographically-diverse group of non-tertiary care health systems, our estimates may be generalizable to the U.S. population.”

Lu and colleagues collected data from the Fibrotic Liver Disease (FOLD) Consortium between 2003 and 2014 to determine the prevalence and incidence rates of PBC in the U.S.

The overall 8-year prevalence of PBC was 29.3 per 100,000 persons, though the prevalence varied significantly by region and patient demographics. From 2006 to 2014, prevalence increased from 21.7 per 100,000 persons to 39.2 per 100,000 persons. Prevalence increased from by 72% among women (33.5 to 57.8 per 100,000 persons) and by 114% among men (7.2 to 15.4 per 100,000 persons).

During the study period, the annual percentage change was 5.8% (95% CI, 5.8-6.3). After multivariate adjustment for region and other covariates, the annual percentage change was significantly different by age, as increases among patients aged 51 to 70 were roughly 3% to 4%, but 7% among the youngest and oldest age categories.

Between 2006 and 2014, the prevalence of PBC was significantly higher in women compared with men (RR = 3.86; 95% CI, 3.71-4) and significantly lower in African-American patients compared with white patients (RR = 0.66; 95% CI, 0.63-0.7) and in Asian and Pacific Islander patients compared with white patients (RR = 0.77; 95% CI, 0.72-0.81).

Overall incidence of PBC did not vary significantly between 2006 and 2014. However, incidence was significantly higher among patients aged 61 to 70 years, women and white patients, which remained consistent over time.

Incidence rates were significantly higher for women compared with men (RR = 3.17; 95% CI, 2.89-3.49), were similar between Asian and Pacific Islander patients and white patients, and significantly lower in African-American patients compared with white patients (RR = 0.83; 95% CI, 0.72-0.95). Compared with patients aged 70 years or older, incidence remained significantly higher in patients aged 61 years to 70 years during the study period.

Between 2004 and 2014, 2,359 of 3,488 patients in the FOLD Consortium with PBC received ursodeoxycholic acid (UDCA) treatment.

Multivariate analysis showed that age at index date, sex, levels of alkaline phosphatase, bilirubin, aspartate aminotransferase and alanine aminotransferase, and UDCA treatment status correlated significantly with overall mortality. Mortality was higher in men than women (HR = 1.48; 95% CI, 1.29-1.7).

“From 2006 to 2014, we observed a significant increase in the prevalence of PBC, without a concomitant increase in incidence. This phenomenon suggests that patients are living longer with the disease and/or being diagnosed earlier in the disease process,” the researchers concluded. “Our findings suggest improvements in both early diagnosis and reduced mortality among PBC patients under routine clinical care in the U.S.” – by Talitha Bennett

Disclosure: Researchers report financial support for this study from Intercept Pharmaceuticals. Lu reports research support from Gilead Pharmaceuticals. Please see the full study for the other authors’ relevant financial disclosures.