Minoru Nakamura1,2, Hisayoshi Kondo3, Atsushi Tanaka4, Atsumasa Komori1, Masahiro Ito1, Kazuhide Yamamoto5, Hiromasa Ohira6, Mikio Zeniya7, Etsuko Hashimoto8, Masao Honda9, Shuichi Kaneko9, Yoshiyuki Ueno10, Kentaro Kikuchi11, Shinji Shimoda12, Kenichi Harada13, Kuniaki Arai9, Yasuhiro Miyake4, Masanori Abe14, Makiko Taniai8, Toshiji Saibara15, Shotaro Sakisaka16, Hajime Takikawa4, Morikazu Onji14, Hirohito Tsubouchi17, Yasuni Nakanuma13, Hiromi Ishibashi1. 1. Clinical Research Center in National Hospital Organization (NHO) Nagasaki Medical Center and Department of Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Omura, Japan. 2. Headquaters of gp210 working in Intractable Hepatobiliary Disease Study Group supported by the Ministry of Health, Labor and Welfare of Japan, Tokyo, Japan. 3. Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 4. Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan. 5. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 6. Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan. 7. Division of Gastroenterology and Hepatology, Tokyo Jikei University School of Medicine, Tokyo, Japan. 8. Department of Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 9. Department of Gastroenterology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. 10. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 11. Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan. 12. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. 13. Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. 14. Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan. 15. Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan. 16. Department of Gastroenterology and Medicine, Fukuoka University School of Medicine, Fukuoka, Japan. 17. Department of Digestive and Lifestyle-related Disease, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan.
Abstract
AIM: The aim of the present study is to evaluate the factors influencing biochemical response to treatment and the value of biochemical response for predicting long-term outcomes in Japanese patients with primary biliary cirrhosis (PBC). METHODS: Biochemical response to ursodeoxycholic acid (UDCA) or UDCA plus bezafibrate was defined as good (≤upper limit of normal [ULN]), fair (≤1.5 × ULN) or poor (>1.5 × ULN) at 2 years after initiation of UDCA treatment. Associations between various factors (including age, sex, autoantibody status and histological variables at baseline), biochemical response to treatment and long-term outcomes were evaluated in 164 Japanese PBC patients. RESULTS: Anti-gp210 positivity and a higher bile duct loss score were significant risk factors for worse alkaline phosphatase (ALP) response (odds ratios [OR], 2.78 and 1.85, respectively). Age, anti-gp210 positivity and anticentromere positivity were significant risk factors for worse alanine aminotransferase (ALT) response (OR, 1.05, 4.0 and 2.77, respectively). Anti-gp210 positivity and a higher hepatitis score were significant risk factors for worse immunoglobulin (Ig)M response (OR, 2.10 and 2.06, respectively). Worse ALP and IgM response were significant risk factors for progression to late-stage disease without jaundice (OR, 2.27 and 2.32, respectively). Worse ALT response was a significant risk factor for progression to late-stage disease with persistent jaundice (OR, 11.11). CONCLUSION: Biochemical response to treatment at 2 years, which is influenced by autoantibody status and histological variables at baseline, can predict long-term outcomes in Japanese patients with PBC.
AIM: The aim of the present study is to evaluate the factors influencing biochemical response to treatment and the value of biochemical response for predicting long-term outcomes in Japanese patients with primary biliary cirrhosis (PBC). METHODS: Biochemical response to ursodeoxycholic acid (UDCA) or UDCA plus bezafibrate was defined as good (≤upper limit of normal [ULN]), fair (≤1.5 × ULN) or poor (>1.5 × ULN) at 2 years after initiation of UDCA treatment. Associations between various factors (including age, sex, autoantibody status and histological variables at baseline), biochemical response to treatment and long-term outcomes were evaluated in 164 Japanese PBC patients. RESULTS: Anti-gp210 positivity and a higher bile duct loss score were significant risk factors for worse alkaline phosphatase (ALP) response (odds ratios [OR], 2.78 and 1.85, respectively). Age, anti-gp210 positivity and anticentromere positivity were significant risk factors for worse alanine aminotransferase (ALT) response (OR, 1.05, 4.0 and 2.77, respectively). Anti-gp210 positivity and a higher hepatitis score were significant risk factors for worse immunoglobulin (Ig)M response (OR, 2.10 and 2.06, respectively). Worse ALP and IgM response were significant risk factors for progression to late-stage disease without jaundice (OR, 2.27 and 2.32, respectively). Worse ALT response was a significant risk factor for progression to late-stage disease with persistent jaundice (OR, 11.11). CONCLUSION: Biochemical response to treatment at 2 years, which is influenced by autoantibody status and histological variables at baseline, can predict long-term outcomes in Japanese patients with PBC.
Authors: Gideon M Hirschfield; Jessica K Dyson; Graeme J M Alexander; Michael H Chapman; Jane Collier; Stefan Hübscher; Imran Patanwala; Stephen P Pereira; Collette Thain; Douglas Thorburn; Dina Tiniakos; Martine Walmsley; George Webster; David E J Jones Journal: Gut Date: 2018-03-28 Impact factor: 23.059