TY  - JOUR
A1  - Wilde, Anne-Christin
A1  - Lieb, Charlotte
A1  - Leicht, Elise
A1  - Greverath, Lena Maria
A1  - Steinhagen, Lara Marleen
A1  - Wald de Chamorro, Nina
A1  - Petersen, Jörg
A1  - Hofmann, Wolf-Peter
A1  - Hinrichsen, Holger
A1  - Heyne, Renate
A1  - Berg, Thomas
A1  - Naumann, Uwe
A1  - Schwenzer, Jeannette
A1  - Vermehren, Johannes
A1  - Geier, Andreas
A1  - Tacke, Frank
A1  - Müller, Tobias
T1  - Real-world clinical management of patients with primary biliary cholangitis - a retrospective multicenter study from Germany
T2  - Journal of Clinical Medicine
N2  - Background: Clinical practice guidelines for patients with primary biliary cholangitis (PBC) have been recently revised and implemented for well-established response criteria to standard first-line ursodeoxycholic acid (UDCA) therapy at 12 months after treatment initiation for the early identification of high-risk patients with inadequate treatment responses who may require treatment modification. However, there are only very limited data concerning the real-world clinical management of patients with PBC in Germany. Objective: The aim of this retrospective multicenter study was to evaluate response rates to standard first-line UDCA therapy and subsequent Second-line treatment regimens in a large cohort of well-characterized patients with PBC from 10 independent hepatological referral centers in Germany prior to the introduction of obeticholic acid as a licensed second-line treatment option. Methods: Diagnostic confirmation of PBC, standard first-line UDCA treatment regimens and response rates at 12 months according to Paris-I, Paris-II, and Barcelona criteria, the follow-up cut-off alkaline phosphatase (ALP) ≤ 1.67 × upper limit of normal (ULN) and the normalization of bilirubin (bilirubin ≤ 1 × ULN) were retrospectively examined between June 1986 and March 2017. The management and hitherto applied second-line treatment regimens in patients with an inadequate response to UDCA and subsequent response rates at 12 months were also evaluated. Results: Overall, 480 PBC patients were included in this study. The median UDCA dosage was 13.2 mg UDCA/kg bodyweight (BW)/d. Adequate UDCA treatment response rates according to Paris-I, Paris-II, and Barcelona criteria were observed in 91, 71.3, and 61.3% of patients, respectively. In 83.8% of patients, ALP ≤ 1.67 × ULN were achieved. A total of 116 patients (24.2%) showed an inadequate response to UDCA according to at least one criterion. The diverse second-line treatment regimens applied led to significantly higher response rates according to Paris-II (35 vs. 60%, p = 0.005), Barcelona (13 vs. 34%, p = 0.0005), ALP ≤ 1.67 × ULN and bilirubin ≤ 1 × ULN (52.1 vs. 75%, p = 0.002). The addition of bezafibrates appeared to induce the strongest beneficial effect in this cohort (Paris II: 24 vs. 74%, p = 0.004; Barcelona: 50 vs. 84%, p = 0.046; ALP < 1.67 × ULN and bilirubin ≤ 1 × ULN: 33 vs. 86%, p = 0.001). Conclusion: Our large retrospective multicenter study confirms high response rates following UDCA first-line standard treatment in patients with PBC and highlights the need for close monitoring and early treatment modification in high-risk patients with an insufficient response to UDCA since early treatment modification significantly increases subsequent response rates of these patients.
KW  - primary biliary cholangitis
KW  - autoantibodies
KW  - ursodeoxycholic acid
KW  - treatment response
KW  - second line therapy
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62150
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-621506
SN  - 2077-0383
N1  - This study was supported by the German Research Foundation Grants MU 2864/1-3 and MU 2864/3-1 and by unrestricted research grants from Intercept Pharmaceuticals and Falk Pharma GmbH. The supporting parties had no influence on the study design, data collection and analyses, writing of the manuscript or on the decision to submit the manuscript for publication.
VL  - 10
IS  - 5, art. 1061
SP  - 1
EP  - 11
PB  - MDPI
CY  - Basel
ER  -