BACKGROUND: Treatment of primary biliary cirrhosis with ursodiol or colchicine may stabilize the disease or slow its rate of progression, but no reports of spontaneous or treatment-related remission have been published. OBJECTIVE: To determine whether primary biliary cirrhosis fully responds to low-dose oral methotrexate therapy. DESIGN: Prospective case study with at least 6 years of observation. SETTING: Academic medical center. PATIENTS: 5 of 19 patients with biopsy-proven precirrhotic primary biliary cirrhosis who had been ill for at least 1 year. Three of the 5 had not responded to colchicine or had responded only partially. INTERVENTION: Oral methotrexate, 15 mg/wk in divided doses. MEASUREMENTS: Symptoms, biochemical tests of liver function, and percutaneous liver biopsies. The latter were done at baseline, 1 to 2 years after initiation of methotrexate therapy, and then every 2 to 3 years during methotrexate therapy. RESULTS: All 5 patients completely responded to medical treatment. Results of biochemical tests of liver function, became normal, symptoms remitted, and serial liver biopsy specimens showed progressive histologic improvement. Biopsy specimens obtained after 5 to 12 years of treatment showed few signs of primary biliary cirrhosis and, in 3 patients, were close to normal. Five of the other 14 patients have responded biochemically and have shown histologic improvement; the other 9 have not responded to methotrexate therapy, have discontinued therapy, or have been lost to follow-up. CONCLUSION: In some patients, primary biliary cirrhosis may remit in response to methotrexate alone or in combination with colchicine or ursodiol.
BACKGROUND: Treatment of primary biliary cirrhosis with ursodiol or colchicine may stabilize the disease or slow its rate of progression, but no reports of spontaneous or treatment-related remission have been published. OBJECTIVE: To determine whether primary biliary cirrhosis fully responds to low-dose oral methotrexate therapy. DESIGN: Prospective case study with at least 6 years of observation. SETTING: Academic medical center. PATIENTS: 5 of 19 patients with biopsy-proven precirrhotic primary biliary cirrhosis who had been ill for at least 1 year. Three of the 5 had not responded to colchicine or had responded only partially. INTERVENTION: Oral methotrexate, 15 mg/wk in divided doses. MEASUREMENTS: Symptoms, biochemical tests of liver function, and percutaneous liver biopsies. The latter were done at baseline, 1 to 2 years after initiation of methotrexate therapy, and then every 2 to 3 years during methotrexate therapy. RESULTS: All 5 patients completely responded to medical treatment. Results of biochemical tests of liver function, became normal, symptoms remitted, and serial liver biopsy specimens showed progressive histologic improvement. Biopsy specimens obtained after 5 to 12 years of treatment showed few signs of primary biliary cirrhosis and, in 3 patients, were close to normal. Five of the other 14 patients have responded biochemically and have shown histologic improvement; the other 9 have not responded to methotrexate therapy, have discontinued therapy, or have been lost to follow-up. CONCLUSION: In some patients, primary biliary cirrhosis may remit in response to methotrexate alone or in combination with colchicine or ursodiol.
Authors: Seung Up Kim; Jun Yong Park; Do Young Kim; Sang Hoon Ahn; Eun Hee Choi; Jae Yeon Seok; Jung Min Lee; Young Nyun Park; Chae Yoon Chon; Kwang-Hyub Han Journal: Hepatol Int Date: 2010-08-04 Impact factor: 6.047
Authors: Andrea Crosignani; Pier-Maria Battezzati; Pietro Invernizzi; Carlo Selmi; Elena Prina; Mauro Podda Journal: World J Gastroenterol Date: 2008-06-07 Impact factor: 5.742
Authors: Ahmed F Abdalla; Khaled R Zalata; Abeer F Ismail; Gamal Shiha; Mohamed Attiya; Ahmed Abo-Alyazeed Journal: Fibrogenesis Tissue Repair Date: 2009-04-02