High dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis is safe and effective.

Journal article

BACKGROUND/AIMS: Ursodeoxycholic acid (UDCA) has been shown to improve serum liver tests in primary sclerosing cholangitis (PSC), but controlled trials have shown inconsistent effects on liver histology, and did not reveal a survival benefit. This pilot, randomised dose-ranging trial attempted to determine whether further enrichment of the bile acid pool with UDCA would lead to an improvement in outcome for PSC patients. METHODS: Thirty-one patients with PSC were randomised to treatment with either 10 mg/kg (low dose), 20 mg/kg (standard dose) or 30 mg/kg (high dose) daily of UDCA for 2 years. Patients were assessed every 12 weeks and underwent liver biopsy at the beginning and end of the trial. RESULTS: Serum liver tests improved in all groups taking UDCA. Survival probability at 1-4 years as evaluated by the Mayo risk score tended to improve for all patients and significantly improved for the high dose group (p<0.02). Only 3 (10%) of all patients had a Ludwig score showing histological deterioration over the trial period. CONCLUSIONS: High dose UDCA is well-tolerated and is associated with an improvement in survival probability. A trend towards stability/improvement in histological stage was also observed. This treatment appears to be effective for PSC and deserves further evaluation.

Authors: Cullen, SN; Rust, C; Fleming, K; Edwards, C; Beuers, U

• Publication status: Published
• Journal: Journal of hepatology
• Volume: 48
• Issue: 5
• Pages: 792-800
• Publication date: 2008-05-01
• DOI: 10.1016/j.jhep.2007.12.023
• EISSN: 1600-0641
• ISSN: 0168-8278
• Language: English
• Keywords: Cholangitis, Sclerosing; Adult; Female; Male; Survival Rate; Ursodeoxycholic Acid; Dose-Response Relationship, Drug; Middle Aged; Humans