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Additive improvement induced by bezafibrate in patients with primary biliary cirrhosis showing refractory response to ursodeoxycholic acid.
MedLine Citation:
PMID:  21443659     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Ursodeoxycholic acid (UDCA) has been widely used in the treatment of patients with primary biliary cirrhosis (PBC). However, some patients are refractory to UDCA. The aim of this study is to clarify the additive improvement induced by bezafibrate in patients refractory to UDCA. Methods: This study was a prospective analysis of 37 consecutive PBC patients. All patients were treated first for 6 months with UDCA, and then with bezafibrate, if their ALP levels did not decrease more than 40% or within normal range after 6 months' treatment with UDCA. Clinical parameters were monitored for subsequent 24 months. Result: Twenty two patients (59%) achieved improvement of ALP levels after the treatment with UDCA. Those patients (Group A) had significantly lower levels of ALP at diagnosis than those with abnormal ALP levels after 6 months' treatment with UDCA (Group B; p = 0.020). They continued UDCA monotherapy, and maintained normal ALP levels at subsequent follow-ups. However, immunoglobulin M (IgM) levels remained abnormal in 8 patients, whose IgM levels at the time of diagnosis were significantly higher than those whose IgM were normalized after 6 months' treatment with UDCA (p = 0.026). Those in Group B were treated additionally with bezafibrate, and 12 patients (80%) achieved normal ALP and IgM levels within 12 months of commencement of therapy. Conclusion: Higher ALP level at diagnosis is one of the predictors for UDCA failure. Combination treatment of bezafibrate in addition to UDCA may be an effective treatment for PBC patients refractory to UDCA.
Authors:
Yasuto Takeuchi; Fusao Ikeda; Shin-Ichi Fujioka; Toshiyuki Takaki; Toshiya Osawa; Tetsuya Yasunaka; Yasuhiro Miyake; Akinobu Takaki; Yoshiaki Iwasaki; Haruhiko Kobashi; Kazuhide Yamamoto; Tatsuya Itoshima
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-28
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  -     ISSN:  1440-1746     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
Affiliation:
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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