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Published on: February 10, 2015
Ursodeoxycholic acid therapy in primary biliary cirrhosis
1Dept. of Gastroenterology, Johann Wolfgang Goethe Universität, Frankfurt am Main, Germany.
Ursodeoxycholic acid (UDCA) treatment offers significant relief from itching and improves liver enzyme levels in patients. While its effects on liver histology and transplant outcomes show mixed results, UDCA is considered a safe therapy.
Area of Science:
- Hepatology
- Gastroenterology
- Pharmacology
Background:
- Cholestatic liver diseases are characterized by impaired bile flow.
- Ursodeoxycholic acid (UDCA) is a naturally occurring bile acid used therapeutically.
- The efficacy and mechanisms of UDCA in liver diseases require further elucidation.
Purpose of the Study:
- To evaluate the effects of ursodeoxycholic acid (UDCA) on symptoms, biochemical markers, liver histology, and clinical outcomes in patients with liver diseases.
- To assess the safety and tolerability of UDCA therapy.
- To explore the impact of UDCA on bile acid composition.
Main Methods:
- Systematic review and meta-analysis of 11 controlled clinical trials involving 1004 patients.
- Assessment of outcomes including pruritus, serum liver enzymes (aminotransferases, cholestasis-indicating enzymes), serum bilirubin, liver histology, and time to liver transplantation/death.
- Analysis of UDCA's proportion in total bile acids and its effect on other bile acid levels.
Main Results:
- UDCA treatment (8-15 mg/kg/day) decreased pruritus in 30-60% of patients.
- Significant reductions observed in serum aminotransferases (20-80%), cholestasis-indicating enzymes (20-80%), and serum bilirubin (3-40%).
- Liver histology showed statistically significant improvement in only two studies, with a positive trend in three others. Transplant-free survival data were inconclusive, with one study showing a definite prolongation and two showing a positive trend.
Conclusions:
- UDCA is effective in alleviating pruritus and improving biochemical liver function tests in patients with liver diseases.
- The impact of UDCA on liver histology and long-term clinical outcomes like transplantation and survival remains uncertain.
- UDCA is a safe therapeutic agent, but its precise mechanism of action in liver diseases is still unknown.
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