TY  - JOUR
A1  - Wilde, Anne-Christin Beatrice
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  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/23400
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-234003
SN  - 2077-0383
VL  - 10
IS  - 5
ER  -