Ursodeoxycholic acid response tied to lower mortality in PBC with cirrhosis

Ursodeoxycholic acid (UDCA) response contributes to a decrease in decompensation, all-cause, and liver-related death or transplantation in predominantly male patients with cirrhosis, reveals a study, noting the highest benefit in those with portal hypertension.

“Patients with cirrhosis and men have been under-represented in most studies examining the clinical benefit of response to UDCA in primary biliary cholangitis (PBC),” the authors said.

To address this, a retrospective cohort study was conducted on veterans, mostly men, with PBC and compensated cirrhosis. The authors examined the relationship of UDCA response with the development of all-cause and liver-related mortality or transplantation, hepatic decompensation, and hepatocellular carcinoma (HCC) using competing risk time-updating Cox proportional hazards models.

Of the 501 veterans with PCB and compensated cirrhosis, 287 were UDCA responders (1,692.8 patient-years [PY] of follow-up) and 214 were partial responders (838.9 PY of follow-up). UDCA responders had lower unadjusted rates of hepatic decompensation (3.8 vs 7.9 per 100 PY; p<0.0001) and liver-related death or transplantation (3.7 vs 6.2 per 100 PY; p<0.0001) than partial responders.

Moreover, UDCA response correlated with a reduced risk of hepatic decompensation (subhazard ratio [sHR], 0.54, 95 percent confidence interval [CI], 0.31–0.95; p=0.03), death from any cause or transplantation (adjusted hazard ratio, 0.49, 95 percent CI, 0.33–0.72; p=0.0002), and liver-related death or transplantation (sHR, 0.40, 95 percent CI, 0.24–0.67; p=0.0004), but not HCC (sHR, 0.39, 95 percent CI, 0.60–2.55; p=0.32).

Sensitivity analysis revealed an association between the presence of portal hypertension and the highest UDCA-related effect.