Ursodeoxycholic acid-induced GLOBE score changes tied to survival in primary biliary cholangitis

In patients with primary biliary cholangitis (PBC), changes in the GLOBE score (ΔGLOBE) brought about by treatment with ursodeoxycholic acid (UDCA) are predictive of liver transplantation (LT)-free survival, reports a study.

“While the relative risk reduction of LT or death was stable, the absolute risk reduction was heavily dependent on the baseline prognosis of the patient,” the authors said.

Cox regression analyses were performed to explore the association between ΔGLOBE (ΔGLOBE_0-1: during the first year of UDCA; ΔGLOBE_1-2: during the second year) and the risk of LT or death among UDCA-treated patients within the Global PBC cohort.

A total of 3,775 UCDA-treated patients (median age 54.0 years, median GLOBE score 0.25, 90.7 percent female) were included, of which 730 reached the combined endpoint of LT or death during a median follow-up of 7.2 years. The median ΔGLOBE_0-1 was ‒0.27.

In Cox regression analyses, adjusted for pretreatment GLOBE score and ΔGLOBE_0–1, an association was observed between ΔGLOBE and LT or death (adjusted hazard ratio [aHR], 2.28, 95 percent confidence interval [CI], 1.81‒2.87; p<0.001). The interaction between baseline GLOBE score and ΔGLOBE_0–1 did not reach statistical significance (p=0.296).

Furthermore, ΔGLOBE_1–2 showed an association with LT or death (aHR, 2.19, 95 percent CI, 1.67‒2.86; p<0.001), independently from the baseline GLOBE score and ΔGLOBE during the first year of UDCA treatment.