Yannick Bacq1, Matthieu le Besco2, Anne-Isabelle Lecuyer3, Chantal Gendrot4, Jérôme Potin5, Christian R Andres4, Alexandre Aubourg2. 1. Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France. Electronic address: bacq@med.univ-tours.fr. 2. Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France. 3. Department of Public Health and Medical Information, University Hospital of Tours, Tours, France. 4. Laboratory of Biochemistry and Molecular Biology, University Hospital of Tours, Tours, France. 5. Department of Obstetrics and Gynecology, University Hospital of Tours, Tours, France.
Abstract
BACKGROUND: Ursodeoxycholic acid (UDCA) therapy is commonly used in intrahepatic cholestasis of pregnancy (ICP). AIM: To evaluate the efficacy and tolerance of UDCA in real-world conditions and to search for factors predictive of response to treatment. METHODS: This observational study included 98 consecutive patients suffering from pruritus during pregnancy associated with increased ALT levels or total bile acid (TBA) concentrations, without other causes of cholestasis. The entire ABCB4 gene coding sequence was analyzed by DNA sequencing. RESULTS: UDCA was prescribed until delivery in all patients (mean dose 14.0mg/kg/day; mean duration 30.4 days). Pruritus improved in 75/98 (76.5%) patients, and totally disappeared before delivery in 25/98 (25.5%). After 2-3 weeks of treatment, ALT levels decreased by more than 50% of base line in 67/86 (77.9%) patients and normalized in 34/86 (39.5%), and TBA concentrations decreased in 28/81 (34.6%). Only one patient stopped the treatment before delivery. On multivariate analysis, ALT >175IU/l before treatment was associated with improvement of pruritus (OR 2.97, 95% CI 1.12-7.89, P=0.029) and with decreased ALT (OR 18.61, 95% CI 3.94-87.99, P=0.0002). ABCB4 gene mutation was not associated with response to treatment. CONCLUSION: This study supports the use of UDCA as first line therapy in ICP.
BACKGROUND:Ursodeoxycholic acid (UDCA) therapy is commonly used in intrahepatic cholestasis of pregnancy (ICP). AIM: To evaluate the efficacy and tolerance of UDCA in real-world conditions and to search for factors predictive of response to treatment. METHODS: This observational study included 98 consecutive patients suffering from pruritus during pregnancy associated with increased ALT levels or total bile acid (TBA) concentrations, without other causes of cholestasis. The entire ABCB4 gene coding sequence was analyzed by DNA sequencing. RESULTS: UDCA was prescribed until delivery in all patients (mean dose 14.0mg/kg/day; mean duration 30.4 days). Pruritus improved in 75/98 (76.5%) patients, and totally disappeared before delivery in 25/98 (25.5%). After 2-3 weeks of treatment, ALT levels decreased by more than 50% of base line in 67/86 (77.9%) patients and normalized in 34/86 (39.5%), and TBA concentrations decreased in 28/81 (34.6%). Only one patient stopped the treatment before delivery. On multivariate analysis, ALT >175IU/l before treatment was associated with improvement of pruritus (OR 2.97, 95% CI 1.12-7.89, P=0.029) and with decreased ALT (OR 18.61, 95% CI 3.94-87.99, P=0.0002). ABCB4 gene mutation was not associated with response to treatment. CONCLUSION: This study supports the use of UDCA as first line therapy in ICP.
Authors: Samar H Ibrahim; Maureen M Jonas; Sarah A Taylor; Luz Helena Gutierrez Sanchez; Jaqueline L Wolf; Shikha S Sundaram Journal: Hepatology Date: 2020-03-18 Impact factor: 17.425
Authors: William M Hague; Leonie Callaway; Jennifer Chambers; Lucy Chappell; Suzette Coat; Jiska de Haan-Jebbink; Marloes Dekker; Peter Dixon; Jodie Dodd; Maria Fuller; Sanne Gordijn; Dorothy Graham; Oskari Heikinheimo; Annemarie Hennessy; Risto Kaaja; Teck Yee Khong; Laura Lampio; Jennie Louise; Angela Makris; Corey Markus; Hanns-Ulrich Marschall; Philippa Middleton; Ben W Mol; Jonathan Morris; John P Newnham; Caroline Ovadia; Michael Peek; Antonia Shand; Michael Stark; Jim Thornton; Susanna Timonen; Susan Walker; David Warrilow; Catherine Williamson Journal: BMC Pregnancy Childbirth Date: 2021-01-12 Impact factor: 3.007