The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: Results of a 9year follow-up

Jones, David; Al‐Rifai, Ahmad; Frith, James; Patanwala, Imran; Newton, Julia L.

doi:10.1016/j.jhep.2010.05.026

Cited by 84 publications

(60 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Já em outro estudo observacional e prospectivo, com 209 pacientes e 12 anos de acompanhamento, a terapia em longo prazo com AUDC não alterou a progressão da doença em pacientes com CBP, apesar de melhoras significativas na bilirrubina sérica e na fosfatase alcalina (Chan et al, 2005). Jones et al, 2010(Jones et al, 2010 concluíram em um estudo prospectivo e longitudinal que o não tratamento com AUDC foi especificamente associado com risco aumentado de morte na CBP.…”

Section: Descrição Dos Estudos Selecionadosunclassified

“…As primeiras metanálises publicadas sobre a eficácia do tratamento da CBP com AUDC não mostraram resultados favoráveis, porém seus períodos de acompanhamento variaram de 9 a 64 meses e de 3 a 92 meses, com mediana de 24 meses . Estudos individuais publicados posteriormente, com períodos mais extensos de acompanhamento, mostraram resultados promissores em termos de ganho de sobrevida e sobrevida livre de transplante (SLT) de fígado Chan et al, 2005;Floreani et al, 2011;Jones et al, 2010;Jorgensen et al, 2002;Parés et al, 2006;Poupon et al, 1999;Poupon et al, 2003;. Dessa forma, com o objetivo de avaliar essa lacuna no conhecimento, uma revisão sistemática da literatura com metanálise sobre o impacto em longo prazo do tratamento com AUDC nos pacientes com CBP foi realizada.…”

Section: Introductionunclassified

See 1 more Smart Citation

O tratamento contínuo superior a cinco anos com ácido ursodesoxicólico gera benefícios na taxa de mortalidade e na taxa de transplantes em colangite biliar primária: revisão sistemática da literatura e metanálise

Júnior¹,

Menezes²,

Fahham³

et al. 2018

JBES

View full text Add to dashboard Cite

O tratamento contínuo superior a cinco anos com ácido ursodesoxicólico gera benefícios na taxa de mortalidade e na taxa de transplantes em colangite biliar primária: revisão sistemática da literatura e metanálise RESUMOObjetivos: A colangite biliar primária (CBP) é uma doença hepática colestática, autoimune, inflamatória e crônica que, quando não tratada, evolui para cirrose e eventualmente insuficiência hepática em um período de 10 a 20 anos. Este estudo teve como objetivo avaliar o impacto em longo prazo do tratamento com ácido ursodesoxicólico (AUDC) em pacientes com CBP. Métodos: Uma revisão sistemática da literatura foi conduzida até maio de 2017. Os desfechos incluíram sobrevida livre de transplante (SLT) ou morte, sobrevida global (SG), taxa de mortalidade, taxa de transplantes e a taxa combinada de mortes e transplantes. A análise dos dados foi realizada por meio de um modelo de efeitos aleatórios, utilizando-se o método de DerSimonian e Laird. Resultados: Doze estudos foram incluídos na metanálise. O tratamento com AUDC apresentou aumento do tempo de SLT no acompanhamento em longo prazo a partir do quinto ano de tratamento, com resultados estatisticamente significativos para os anos de 5 e 10 (p < 0,01). Os resultados da metanálise das taxas de mortalidade, transplante e taxa combinada de mortalidade e transplante mostraram-se não significativos para os três desfechos apresentados. A inclusão dos estudos de braço comparador teórico alterou de maneira significativa os resultados da análise principal, tornando os resultados estatisticamente significativos a partir do terceiro ano de acompanhamento. Conclusões: AUDC é eficaz no aumento da SLT ou morte, com resultados estatisticamente significativos em 5 e 10 anos, quando os pacientes são tratados de maneira crônica.

show abstract

Section: Descrição Dos Estudos Selecionadosunclassified

Section: Introductionunclassified

O tratamento contínuo superior a cinco anos com ácido ursodesoxicólico gera benefícios na taxa de mortalidade e na taxa de transplantes em colangite biliar primária: revisão sistemática da literatura e metanálise

Júnior¹,

Menezes²,

Fahham³

et al. 2018

JBES

View full text Add to dashboard Cite

show abstract

“…This change is linked to systemic symptoms of fatigue and cognitive impairment. The fatigue phenotype appears to be highly stable and its presence is independently associated with a significantly risk of death in general, and cardiac death in particular [9,10]. It might not disappeared after liver transplantation [11].…”

Section: Introductionmentioning

confidence: 99%

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Raszeja‐Wyszomirska¹,

Zorga²,

Kotulski³

et al. 2017

IJCEMS

View full text Add to dashboard Cite

Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium 99m labeled exametazime ( 99m Tc -HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.

show abstract

“…Primary therapy with ursodeoxycholic acid (UDCA) is effective in the majority of people and 50% of patients unresponsive to UDCA have been shown to respond to the first of the second-line agents, obeticholic acid (OCA), a Farnesoid X receptor (FXR) agonist. 10,11 Combination therapy with UDCA and fenofibrate has also been proposed for patients who exhibit an incomplete UDCA response, however, high quality trial data are currently lacking. 12,13 The proposed paradigm for OCA at present is to restrict its use to patients who have demonstrated lack of response to UDCA.…”

Section: Introductionmentioning

confidence: 99%

“…When used in this way, the trials of OCA show no benefit in terms of fatigue or cognitive impairment in PBC patients, and this remains a frustrating aspect of the otherwise very promising therapy profile for this agent. 10 One possible explanation for the lack of benefit on CNS symptoms of an otherwise highly effective agent could be that brain change in PBC (which has already been demonstrated to be irreversible following transplantation) may be something which actually develops from early in the disease process, rather than being a late-stage phenomenon. It may, therefore, be that the current treatment paradigm for OCA mitigates against beneficial effect on brain change.…”

Section: Introductionmentioning

confidence: 99%

Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging

Kim

Grover

Southern

et al. 2017

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: Results of a 9year follow-up

Cited by 84 publications

References 27 publications

O tratamento contínuo superior a cinco anos com ácido ursodesoxicólico gera benefícios na taxa de mortalidade e na taxa de transplantes em colangite biliar primária: revisão sistemática da literatura e metanálise

O tratamento contínuo superior a cinco anos com ácido ursodesoxicólico gera benefícios na taxa de mortalidade e na taxa de transplantes em colangite biliar primária: revisão sistemática da literatura e metanálise

Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging

Contact Info

Product

Resources

About