Document Detail


The use of methotrexate, colchicine, and other immunomodulatory drugs in the treatment of primary biliary cirrhosis.
MedLine Citation:
PMID:  9170200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Primary biliary cirrhosis (PBC) is an immunologically mediated disease in which activated T lymphocytes attack and destroy epithelial cells in the small intralobular bile ducts of genetically susceptible patients. This article reviews the results of treatment of PBC with immunomodulatory agents. Results with drugs such as glucocorticoids, azathioprine, and chlorambucil have been disappointing because of either limited efficacy (azathioprine), toxicity (chlorambucil), or both (glucocorticoids). Colchicine improved tests of liver function in three prospective studies and was associated with improved survival for up to 4 years. However, survival benefits were lost at 8 years. Colchicine appears to slow the rate of progression of PBC but not to stop it. Preliminary results suggest that colchicine may have synergistic effects if used together with ursodeoxycholic acid, particularly in patients who are only partially responsive to ursodeoxycholic acid. Results with cyclosporine have been disappointing because of limited efficacy and predictable toxicity. The modest improvement in tests of liver function and survival are counterbalanced by the development of hypertension in some and worsening renal function in most. There is little beneficial effect on symptoms or histology. Results with methotrexate are promising. There are improvements in symptoms and tests of liver function that are equal to those seen with ursodeoxycholic acid and significant improvement in liver histology. Some patients, particularly those with striking inflammation and granulomas in portal triads, appear to have achieved sustained remission while on methotrexate. The effects of methotrexate are additive to those of ursodeoxycholic acid in patients whose blood tests have responded only partially to ursodeoxycholic acid. The most effective treatment of PBC will most likely use a combination of drugs such as ursodeoxycholic acid, colchicine, and methotrexate.
Authors:
M M Kaplan
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in liver disease     Volume:  17     ISSN:  0272-8087     ISO Abbreviation:  Semin. Liver Dis.     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-08-25     Completed Date:  1997-08-25     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8110297     Medline TA:  Semin Liver Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  129-36     Citation Subset:  IM    
Affiliation:
Tufts-New England Medical Center, Tupper Research Institute, Boston, Massachusetts 02111, USA.
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MeSH Terms
Descriptor/Qualifier:
Adjuvants, Immunologic / therapeutic use*
Cholagogues and Choleretics / therapeutic use*
Colchicine / therapeutic use*
Disease Progression
Drug Therapy, Combination
Female
Gout Suppressants / therapeutic use*
Humans
Immunosuppressive Agents / therapeutic use*
Liver Cirrhosis, Biliary / drug therapy*
Male
Methotrexate / therapeutic use*
Ursodeoxycholic Acid / therapeutic use*
Chemical
Reg. No./Substance:
0/Adjuvants, Immunologic; 0/Cholagogues and Choleretics; 0/Gout Suppressants; 0/Immunosuppressive Agents; 128-13-2/Ursodeoxycholic Acid; 59-05-2/Methotrexate; 64-86-8/Colchicine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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