Poster (15W193)

Response Rate to Ursodeoxycholic Acid in Primary Biliary Cirrhosis

Author(s)

D Storan, A Abu Shanab, J Walsh, C Kiat, S Stewart

Department(s)/Institutions

Centre for Liver Disease, Mater Misericordiae University Hospital, 55 Eccles St, Dublin 7

Introduction

The only approved evidence-based treatment for patients with PBC is ursodeoxycholic acid (UDCA), a hydrophilic, non-cytotoxic bile acid (BA). UDCA at the recommended dose of 13 to 15 mg/kg per day delays the progression to end-stage liver disease, enhances survival, and is well tolerated1, 2. The validated Toronto criterion for response to UDCA (ALP<1.67×ULN at 2 years) correlates well with long-term survival3. Second-line agents such as obeticholic acid should soon be available to treat nonresponders. Data from the UK suggests that many PBC patients are under-treated with UDCA and that response rates in those adequately treated reach 60%.

Aims/Background

We sought to determine the adequacy of, and response to, UDCA treatment in our PBC cohort in order to cohort patients for second-line therapies.

Method

A search was performed on the HIPE Reporting Database for all patients with PBC listed as a primary or secondary diagnosis from 1/1/2005 to 31/12/2014. This returned a total of 85 patients, however after duplicate and deceased patients were removed, a total of 51 patients were identified. Data was analysed using Microsoft Excel.

Results

Of the 51 patients, 48 (94%) were female and the mean age was 66 (33-91). 80% were AMA +ve. 29 of the 48 (60%) patients receiving UDCA were on an adequate weight-based dose. 33/48 (69%) receiving UDCA and 16/29 (55%) of those on an adequate dose reached the Toronto criterion for response.

Conclusions

Our study has highlighted that UDCA treatment is suboptimal in many of our PBC patients. Even with adequate therapy, however, 45% are non-responders and suitable for second line therapies.