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Updated: May 14, 2026

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis
Published on: February 10, 2015
Long-term add-on fibrate therapy in Primary Sclerosing Cholangitis: Safety, biochemical response, and disease
E Catanzaro1, M Peviani1, E Bonaiuto2
1Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università Padova, Padova, Italy; ERN RARE-LIVER - European Reference Network on Rare Hepatological Diseases.
Background And Aims:
Fibrates may improve cholestasis and pruritus in Primary Sclerosing Cholangitis (PSC), but long-term data is limited. This study assessed the safety and biochemical, radiological, and clinical effects of fibrates in PSC.
Method:
We retrospectively analysed PSC patients on stable UDCA therapy who received add-on fibrates between 2017 and 2025. Clinical, biochemical, radiological, and elastography data were collected to assess treatment response, safety, and disease progression.
Results:
Of 37 PSC patients initiating fibrates, 34 were included, 21% with cirrhosis. Fenofibrate was used in 88% for a median of 34 months. Significant reductions in ALP, GGT, and ALT were observed at 6 months and sustained over follow-up. The proportion of patients with ALP < 1.5 × ULN increased from 22% to 45% at 6 months. The Amsterdam-Oxford score (AOM) decreased significantly at 6 and 12 months (p = 0.02). Responders had lower baseline bilirubin, transaminases, AOM, and Mayo Risk score (p < 0.05). Pruritus improved while fatigue, cholangitis frequence, and liver stiffness remain unchanged. MRI follow-up showed worsening of ANALI score due to bile duct dilatation, with stable DiStrict score. Adverse events occurred in 15%, leading to discontinuation in 4 patients.
Conclusion:
Fibrates appear to be a safe and potentially effective option in PSC, especially in early-stage disease, pending confirmation from prospective trials.
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