Fenofibrate is effective adjunctive therapy in the treatment of primary biliary cirrhosis: A meta-analysis

Grigorian, Alla; Mardini, Houssam; Corpechot, Christophe; Poupon, Raoul; Levy, Cynthia

doi:10.1016/j.clinre.2015.02.011

Cited by 78 publications

(48 citation statements)

References 24 publications

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“…Fibrates, including bezafibrate and fenofibrate, may be useful for treating asymptomatic patients with PBC who exhibit inappropriate response to UDCA[179-183]. A nationwide retrospective survey in Japan demonstrated that normalizing serum ALT concentrations with accessional bezafibrate therapy observably reduced the occurrence of hepatic illness-associated clinical signs in symptomless patients, with PBC responding incompletely to UDCA[179].…”

Section: Therapy Of Pbcmentioning

confidence: 99%

Recent advances in the diagnosis and treatment of primary biliary cholangitis

Huang¹

2016

WJH

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Primary biliary cholangitis (PBC), formerly referred to as primary biliary cirrhosis, is an infrequent progressive intrahepatic cholestatic autoimmune illness that can evolve into hepatic fibrosis, hepatic cirrhosis, hepatic failure, and, in some cases, hepatocellular carcinoma. The disease itself is characterized by T-lymphocyte-mediated chronic non-suppurative destructive cholangitis and elevated serum levels of extremely specific anti-mitochondrial autoantibodies (AMAs). In this article, we will not only review epidemiology, risk factors, natural history, predictive scores, radiologic approaches (e.g., acoustic radiation force impulse imaging, vibration controlled transient elastography, and magnetic resonance elastography), clinical features, serological characteristics covering biochemical markers, immunoglobulins, infections markers, biomarkers, predictive fibrosis marker, specific antibodies (including AMAs such as AMA-M2), anti-nuclear autoantibodies [such as anti-multiple nuclear dot autoantibodies (anti-sp100, PML, NDP52, anti-sp140), anti-rim-like/membranous anti-nuclear autoantibodies (anti-gp210, anti-p62), anti-centromere autoantibodies, and some of the novel autoantibodies], histopathological characteristics of PBC, diagnostic advances, and anti-diastole of PBC. Furthermore, this review emphasizes the recent advances in research of PBC in terms of therapies, including ursodeoxycholic acid, budesonide, methotrexate, obeticholic acid, cyclosporine A, fibrates such as bezafibrate and fenofibrate, rituximab, mesenchymal stem cells transplant, and hepatic transplant. Currently, hepatic transplant remains the only optimal choice with acknowledged treatment efficiency for end-stage PBC patients.

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Section: Therapy Of Pbcmentioning

confidence: 99%

Recent advances in the diagnosis and treatment of primary biliary cholangitis

Huang¹

2016

WJH

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“…Normalization or decrease of AP below 1.5 UNL across the treatment (17 patients out of 28) was associated with lower severity and early disease, as measured by transient elastography. Favorable consequences of the combination therapy of bezafibrate (400 mg/day) and UDCA (600 mg/day) have [44] . No severe adverse effects from combined treatment with fibrates have been described, but some patients have experienced heartburn or nausea, resulting in treatment discontinuation.…”

Section: Proposals Targeted On Cholestasismentioning

confidence: 99%

Therapy of Primary Biliary Cirrhosis: Novel Approaches for Patients with Suboptimal Response to Ursodeoxycholic Acid

Parés¹

2015

Dig Dis

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Primary biliary cirrhosis (PBC) is a chronic cholestatic disease of presumed autoimmune pathogenesis, characterized by the inflammation and damage of the intrahepatic intermediate and small bile ducts, which eventually results in cirrhosis. A number of randomized and observational and pilot studies using several agents were carried out in the 80s, but no clear results or even harmful effects were reported. Over the past 2 decades, increasing evidence indicates that ursodeoxycholic acid (UDCA) - 13 to 16 mg/kg/day - is the treatment of choice for patients with PBC. Biochemical response to UDCA, assessed at 1 year, clearly predicts the long-term outcome, since in UDCA, responders survival is similar to that estimated for the matched control population. However, about 40% of patients have incomplete biochemical response and increased risk of progression and decreased survival free of transplantation. Patients with suboptimal biochemical response to UDCA outline the group in whom further single or combined treatments with UDCA are needed. Accordingly, data on the effect of fibrates alone or in combination with UDCA, and budesonide in combination with UDCA have been reported. The combined treatment of UDCA and fibrates in patients without optimal biochemical response to UDCA improves the degree of cholestasis and may minimize the long-term management of these patients. The results of the combined therapy of UDCA with budesonide are appealing but they should be established in large randomized trials. The effect of new agents such obeticholic acid are promising, since the addition of this farnesoide-X-receptor agonist bile acid in patients with stable UDCA dosage and increased alkaline phosphatase levels results in an improvement of cholestasis as compared to placebo, with a parallel decrease of aminotransferases and immunoglobulin M, as well as one surrogate marker of bile acid synthesis. New molecular therapies are currently being investigated.

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“…Remarkably, all studies had a high risk of bias, mainly because of questions regarding the randomization and blinding methodologies. In turn, a recent meta-analysis of 6 studies using fenofibrate for 102 patients with PBC and incomplete response to UDCA concluded that treatment is associated with significant reduction of ALP, GGT, TB and IgM (172) . A large, randomized, placebo-controlled study is not yet available to support the use of fibrates as adjuvant therapy in PBC.…”

Section: Rotterdammentioning

confidence: 99%

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

Bittencourt

Cançado

Couto

et al. 2015

Arq. Gastroenterol.

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-In order to draw evidence-based recommendations concerning the management of autoimmune diseases of the liver, the Brazilian Society of Hepatology has sponsored a single-topic meeting in October 18th, 2014 at São Paulo. An organizing committee comprised of seven investigators was previously elected by the Governing Board to organize the scientific agenda as well as to select twenty panelists to make a systematic review of the literature and to present topics related to the diagnosis and treatment of autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis and their overlap syndromes. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript organized in topics, followed by the recommendations of the Brazilian Society of Hepatology.

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Fenofibrate is effective adjunctive therapy in the treatment of primary biliary cirrhosis: A meta-analysis

Cited by 78 publications

References 24 publications

Recent advances in the diagnosis and treatment of primary biliary cholangitis

Recent advances in the diagnosis and treatment of primary biliary cholangitis

Therapy of Primary Biliary Cirrhosis: Novel Approaches for Patients with Suboptimal Response to Ursodeoxycholic Acid

Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver

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