Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis: Predictors of Gamma Glutamyltransferase Normalization and Favorable Clinical Course - 23/05/19
, Emily Perito, MD 2, Amanda Ricciuto, MD, PhD 3, Nitika Gupta, MD 4, Binita M. Kamath, MD, MBBChir, MRCP 3, Sirish Palle, MD 5, Bernadette Vitola, MD, MPH 6, Vratislav Smolka, MD 7, Federica Ferrari, MD, PHD 8, Achiya Z. Amir, MD 9, Tamir Miloh, MD 10, Alexandra Papadopoulou, MD 11, Parvathi Mohan, MD 12, Cara Mack, MD 13, Kaija-Leena Kolho, MD 14, Raffaele Iorio, MD 15, Wael El-Matary, MD, MSc 16, Veena Venkat, MD 17, Albert Chan, MD 18, Lawrence Saubermann, MD 18, Pamela L. Valentino, MD, MSc 19, Uzma Shah, MBBS 20, Alexander Miethke, MD 21, Henry Lin, MD 22, M.K. Jensen, MD, MS 1Abstract |
Objective |
To investigate patient factors predictive of gamma glutamyltransferase (GGT) normalization following ursodeoxycholic acid (UDCA) therapy in children with primary sclerosing cholangitis.
Study design |
We retrospectively reviewed patient records at 46 centers. We included patients with a baseline serum GGT level ≥50 IU/L at diagnosis of primary sclerosing cholangitis who initiated UDCA therapy within 1 month and continued therapy for at least 1 year. We defined “normalization” as a GGT level <50 IU/L without experiencing portal hypertensive or dominant stricture events, liver transplantation, or death during the first year.
Results |
We identified 263 patients, median age 12.1 years at diagnosis, treated with UDCA at a median dose of 15 mg/kg/d. Normalization occurred in 46%. Patients with normalization had a lower prevalence of Crohn's disease, lower total bilirubin level, lower aspartate aminotransferase to platelet ratio index, greater platelet count, and greater serum albumin level at diagnosis. The 5-year survival with native liver was 99% in those patients who achieved normalization vs 77% in those who did not.
Conclusions |
Less than one-half of the patients treated with UDCA have a complete GGT normalization in the first year after diagnosis, but this subset of patients has a favorable 5-year outcome. Normalization is less likely in patients with a Crohn's disease phenotype or a laboratory profile suggestive of more advanced hepatobiliary fibrosis. Patients who do not achieve normalization could reasonably stop UDCA, as they are likely not receiving clinical benefit. Alternative treatments with improved efficacy are needed, particularly for patients with already-advanced disease.
Le texte complet de cet article est disponible en PDF.Keywords : juvenile, cholestasis, autoimmune, surrogate endpoint, treatment
Abbreviations : APRI, AST, GGT, IBD, PSC, UDCA
Plan
| Supported by PSC Partners Seeking A Cure, the Primary Children’s Hospital Foundation, and the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR001065 and 8UL1TR000105 [formerly UL1RR025764]). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. M.D. served as a consultant for HighTide Biopharmaceuticals LLC. B.K. is a consultant for Retrophin. T.M. is a consultant, serves on the advisory board, and serves on the speaker board for Alexion. P.M. has received grants from Gilead. The other authors declare no conflicts of interest. |
Vol 209
P. 92 - juin 2019 Retour au numéro
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