Eric M Yoshida1, Mark Gordon Swain2, Cynthia Tsien3, Edward Tam4, Robert James Bailey5, Dusanka Grbic6, Hin Hin Ko7, Alnoor Ramji8, Nir Hilzenrat9, Magdy Elkhashab10, Euiseok Kim11, Meaghan O'Brien12, Marco Amedeo Puglia12, Kevork M Peltekian12. 1. Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada. 2. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada. 3. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 4. Pacific Gastroenterology Associates, Vancouver, British Columbia, Canada. 5. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 6. CIUSSS de l'Estrie CHUS, Université de Sherbrooke, Sherbrooke, Quebec, Canada. 7. Liver Diseases Clinic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 8. Toronto Liver Centre, Toronto, Ontario, Canada. 9. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 10. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 11. Hepatology and Gastroenterology, McMaster University, Hamilton, Ontario, Canada. 12. Division of Digestive Care and Endoscopy, QEII, Nova Scotia Health, Halifax, Nova Scotia, Canada.
Abstract
Background: Primary biliary cholangitis (PBC) is a rare, chronic autoimmune, cholestatic liver disease affecting approximately 318 per million Canadians. There is limited information regarding the characterization of this patient population in Canada. Consequently, we aim to describe a cohort of PBC patients managed across liver centres serving this type of population. Methods: A cross-sectional examination of 1,125 PBC patient charts at 15 liver centres across Canada was conducted between January 2016 and September 2017. Results: Data from 1,125 eligible patients were collected from 7 Canadian provinces. The patient population was largely female (90.2%), had a median overall age of 61.3 years, and a median overall time since diagnosis of 6.4 years. Of the patients included in the study, 89% were on ursodeoxycholic acid (UDCA) therapy at a median dose of 14.0 mg/kg/day and 4.4% were previously treated with UDCA, whereas 6.6% were never treated with UDCA. Of the patients with available data (n = 1067), 289 (27.1%) presented with alkaline phosphatase (ALP) levels ≥200 IU/L and/or total bilirubin levels ≥21 µmol/L. Assessment of UDCA treatment response revealed that 26.6% and 38.3% of patients were inadequate responders according to the Toronto and Paris-II criteria, respectively. Mortality occurred in 1.2% (14) of patients, with liver-related adverse outcomes being more commonly observed in patients who discontinued UDCA compared to those who are currently on treatment (36.3% and 19.6%, respectively). Conclusion: This study showed that Canadian PBC patients present with demographics and features commonly reported in the literature for this disease. Over one third of PBC patients had inadequate response to UDCA treatment or were not currently being treated with UDCA. Consequently, there is a significant unmet therapeutic need in this Canadian PBC population.
Background: Primary biliary cholangitis (PBC) is a rare, chronic autoimmune, cholestatic liver disease affecting approximately 318 per million Canadians. There is limited information regarding the characterization of this patient population in Canada. Consequently, we aim to describe a cohort of PBC patients managed across liver centres serving this type of population. Methods: A cross-sectional examination of 1,125 PBC patient charts at 15 liver centres across Canada was conducted between January 2016 and September 2017. Results: Data from 1,125 eligible patients were collected from 7 Canadian provinces. The patient population was largely female (90.2%), had a median overall age of 61.3 years, and a median overall time since diagnosis of 6.4 years. Of the patients included in the study, 89% were on ursodeoxycholic acid (UDCA) therapy at a median dose of 14.0 mg/kg/day and 4.4% were previously treated with UDCA, whereas 6.6% were never treated with UDCA. Of the patients with available data (n = 1067), 289 (27.1%) presented with alkaline phosphatase (ALP) levels ≥200 IU/L and/or total bilirubin levels ≥21 µmol/L. Assessment of UDCA treatment response revealed that 26.6% and 38.3% of patients were inadequate responders according to the Toronto and Paris-II criteria, respectively. Mortality occurred in 1.2% (14) of patients, with liver-related adverse outcomes being more commonly observed in patients who discontinued UDCA compared to those who are currently on treatment (36.3% and 19.6%, respectively). Conclusion: This study showed that Canadian PBC patients present with demographics and features commonly reported in the literature for this disease. Over one third of PBC patients had inadequate response to UDCA treatment or were not currently being treated with UDCA. Consequently, there is a significant unmet therapeutic need in this Canadian PBC population.
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