Ursodeoxycholic acid in primary sclerosing cholangitis
2012; Wiley; Volume: 35; Issue: 5 Linguagem: Inglês
10.1111/j.1365-2036.2011.04988.x
ISSN1365-2036
AutoresChristos Triantos, Nikolaos Koukias, V. Nikolopoulou, Andrew K. Burroughs,
Tópico(s)Gallbladder and Bile Duct Disorders
ResumoAlimentary Pharmacology & TherapeuticsVolume 35, Issue 5 p. 622-623 Letters to the EditorsFree Access Ursodeoxycholic acid in primary sclerosing cholangitis C. K. Triantos, Corresponding Author C. K. Triantos chtriantos@hotmail.com Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceDepartment of Gastroenterology,, University Hospital of Patras,, Patras GreeceSearch for more papers by this authorN. Koukias, N. Koukias Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceSearch for more papers by this authorV. Nikolopoulou, V. Nikolopoulou Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceSearch for more papers by this authorA. K. Burroughs, A. K. Burroughs The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery,, UCL and Royal Free Hospital,, London, UKSearch for more papers by this author C. K. Triantos, Corresponding Author C. K. Triantos chtriantos@hotmail.com Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceDepartment of Gastroenterology,, University Hospital of Patras,, Patras GreeceSearch for more papers by this authorN. Koukias, N. Koukias Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceSearch for more papers by this authorV. Nikolopoulou, V. Nikolopoulou Department of Gastroenterology,, University Hospital of Patras,, Patras, GreeceSearch for more papers by this authorA. K. Burroughs, A. K. Burroughs The Royal Free Sheila Sherlock Liver Centre and University Department of Surgery,, UCL and Royal Free Hospital,, London, UKSearch for more papers by this author First published: 03 February 2012 https://doi.org/10.1111/j.1365-2036.2011.04988.xCitations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Sirs, The recent study by Imam MH et al.1 reviewed patients previously enrolled in a study that evaluated high ursodeoxycholic acid (UDCA) dose (28–30 mg/kg) in primary sclerosing cholangitis (PSC). UDCA given in earlier histological stages and/or with higher bilirubin values was associated with worse outcomes. The issue of giving UDCA and outcomes in early histological stages is very interesting, and needs attention, as we have discussed in our recent meta-analysis.2 However, the conclusions of the effects of high-dose UDCA1 should be interpreted with caution. Firstly the study is retrospective, secondly no second biopsies were performed, so data regarding histological progression are not available, and lastly serum IgG4 concentrations were not evaluated. In addition, certain important groups of patients were excluded; those with previous intraductal stones, or interventions on the biliary tree (excluding cholecystectomy), such as biliary drainage preceding the diagnosis of PSC, or recurrent cholangitis requiring hospitalisation occurring more than twice per year. The mechanism or associated factors that could explain why high UDCA doses (28–30 mg/kg) were harmful in early stages is not known. Unfortunately our meta-analysis2 did not allow confirmatory evidence to be established, as randomised trials that evaluated standard UDCA doses, did not give specific data, according to baseline histological stage of PSC. Taking into consideration that a long duration of lower dose UDCA trial in PSC has found no adverse events,3 and that recent data suggest a possible protective role of lower UDCA doses against colorectal carcinoma4 in PSC, there may still be a role for UDCA, but a large multicentre trial from different geographical regions is needed.2 Lastly, as many PSC patients worldwide have taken high-dose UDCA, we suggest that a register be set up to establish if unfavourable outcomes are confirmed. Although this would be retrospective, survival analysis would be robust. Such a register may be the only way to provide data to validate the findings by Imam et al.1 Acknowledgements Declaration of personal interests: Dr CK Triantos has served as a speaker for Gilead. Declaration of funding interests: None. References 1Imam MH, Sinakos E, Gossard AA, et al.High-dose ursodeoxycholic acid increases risk of adverse outcomes in patients with early stage primary sclerosing cholangitis. Aliment Pharmacol Ther 2011; 34: 1185– 92. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2Triantos CK, Koukias NM, Nikolopoulou VN, Burroughs AK. Meta-analysis: ursodeoxycholic acid for primary sclerosing cholangitis. Aliment Pharmacol Ther 2011; 34: 901– 10. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 3Olsson R, Boberg KM, de Muckadell OS, et al. High-dose ursodeoxycholic acid in primary sclerosing cholangitis: a 5-year multicenter, randomized, controlled study. Gastroenterology 2005; 129: 1464– 72. CrossrefCASPubMedWeb of Science®Google Scholar 4Pardi DS, Loftus EV Jr, Kremers WK, Keach J, Lindor KD. Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative colitis and primary sclerosing cholangitis. Gastroenterology 2003; 124: 889– 93. CrossrefCASPubMedWeb of Science®Google Scholar Citing Literature Volume35, Issue5March 2012Pages 622-623 ReferencesRelatedInformation
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