Autoimmune liver disease highlights from ILC 2018

Autoimmune liver diseases, such as primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis, have limited treatment options and may require liver transplantation if treatment is unsuccessful. At the International Liver Congress 2018, several hepatology experts presented data on emerging treatment regimens.

The following reports and exclusive video interviews detail these potential treatment options, including combination obeticholic acid with ursodeoxycholic acid or budesonide add-on therapy for PBC, as well as recent reports on disease outcomes.

ILC 2018 offers hope in autoimmune liver disease: PBC, PSC, hepatitis

In this exclusive interview, Gideon M. Hirschfield, MD, PhD, from the Centre for Liver Research, University of Birmingham, discusses the latest developments in treatments for primary biliary cholangitis, primary sclerosing cholangitis and autoimmune hepatitis, as presented at the International Liver Congress 2018.

“It’s a very exciting meeting for us autoimmune liver disease world, because across the three diseases all with unmet need — PBC, PSC and autoimmune hepatitis — there are opportunities to learn about new science, new therapies and new approaches to treating our patients,” Hirschfield told Healio Gastroenterology and Liver Disease. Watch here

Statins associated with lower risk for liver transplant, death in PSC

Patients with primary sclerosing cholangitis who took statins – likely for another indication – showed reduced risk for transplant and morbidity, according to a presenter at the International Liver Congress 2018.

“Statins ... was the drug [class] that was most beneficial for this patient population,” Annika Bergquist, MD, PhD, of the unit of gastroenterology and rheumatology, Karolinska Institutet, Stockholm, said during a press conference. Read more

Budesonide decreases serum alkaline phosphatase in PBC

Budesonide add-on therapy to ursodeoxycholic acid did not significantly improve histology in high-risk patients with primary biliary cholangitis, the combination showed meaningful improvements in biochemical markers of disease activity, according to a presentation at the International Liver Congress 2018.

“We have very clear guidelines now from EASL about the management of PBC, for which the goals of treatment are to prevent end-stage liver disease and to manage associated symptoms.” Gideon M. Hirschfield, MD, PhD, from the Centre for Liver Research, University of Birmingham, said in his presentation. “We are interested to understand the role of a therapy such as budesonide for those patients with inflammatory phenotypes of PBC, features of autoimmune hepatitis, and inadequate response to current therapies.” Read more

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Obeticholic acid improved, stabilized fibrosis after incomplete response to UDCA

Most patients with primary biliary cholangitis who had an incomplete response to ursodeoxycholic acid achieved stabilization or regression of fibrosis after 3 years of treatment with obeticholic acid, according to a presentation at the International Liver Congress 2018.

“PBC, as you know, is an autoimmune liver disease which attacks the bile ducts and the liver and can lead to cirrhosis, liver failure and liver transplantation,” Christopher L. Bowlus, MD, from the University of California at Davis, Sacramento, told Healio Gastroenterology and Liver Disease. “Most patients are treated with ursodeoxycholic acid and many of them have a complete biochemical response, which essentially is normalization of their liver tests.” Watch here

Reduction of autotaxin may decrease itch in cholestatic liver disease

Reduced serum bile acids after treatment with the ileal bile acid transporter inhibitor A4250 correlated with reductions in autotaxin levels among children with cholestatic liver disease and pruritus, according to a presentation at the International Liver Congress 2018.

“Chronic cholestatic liver disease can be responsible for severe itching, especially in children, with devastating consequences on the quality of life and the quality of sleep,” Emmanuel Gonzalès, MD, PhD, from the University Hospitals of Paris-Sud, France, told Healio Gastroenterology and Liver Disease. “The pathology for this cholestatic itching is not completely understood, but recently it was found that autotaxin ... may be involved.” Read more