USDA Efficacy in PBC with Compensated Cirrhosis

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A retrospective cohort study of veterans, predominantly men with PBC and compensated cirrhosis were evaluated to assess the association of response to UDCA with the development of all-cause and liver-related mortality for transplantation, hepatic decompensation, and HCC-using, competing risk time-updating Cox proportional hazards models.  A total of 501 subjects with PBC and compensated cirrhosis, including 287 UDCA responders, (1692.8 patient-years {PY} of follow-up) and 214 partial responders (838.9 PY of follow-up). The unadjusted rates of hepatic decompensation (3.8 vs 7.9 per 100 PY), and liverrelated death or transplantation (3.7 vs 6.2 per PY), were lower in UDCA responders compared with partial responders. UDCA response was associated with a lower risk of hepatic decompensation (subhazard ratio {sHR} 0.54), death from any cause or transplantation (aHR 0.49), and liverrelated death or transplantation (sHR 0.40), but not HCC (sHR 0.39). In a sensitivity analysis, the presence of portal hypertension was associated with the highest UDCA-associated effect. 

It was concluded that UDCA response is associated with a reduction in decompensation, all-cause, and liver-related death or transplantation in a cohort of predominantly male patients with cirrhosis, with the highest benefit in patients with portal hypertension.

John, B., Khakoo, N., Schwartz, K., et al. “Ursodeoxycholic Acid Response is Associated with Reduced Mortality in Primary Biliary Cholangitis with Compensated Cirrhosis.” American Journal of Gastroenterology; Vol. 116, September 2021, pp. 1913-1923.

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