Liver transplant-free survival according to alkaline phosphatase and GLOBE score in patients with primary biliary cholangitis treated with ursodeoxycholic acid.
Alimentary pharmacology & therapeutics
washington; swedish; GLOBE score; primary biliary cholangitis; second-line treatment; treatment response; Alkaline Phosphatase; Cholagogues and Choleretics; Humans; Liver Cirrhosis, Biliary; Liver Transplantation; Ursodeoxycholic Acid
BACKGROUND: After 1 year of ursodeoxycholic acid (UDCA), patients with primary biliary cholangitis (PBC) may have a normal GLOBE score despite high alkaline phosphatase (ALP) levels.
AIM: To assess the association between ALP and liver transplantation (LT)-free survival according to the GLOBE score METHODS: Among patients with a normal or elevated GLOBE score in the Global PBC cohort, the association between ALP after 1 year of UDCA and the risk of LT/death was assessed. The LT-free survival was compared with that of a matched general population.
RESULTS: After 1 year of UDCA, ALP was associated with the risk of LT/death (aHR 1.31, 95% CI 1.003-1.72, p = 0.048) among 2729 patients with a normal GLOBE score. The 10-year LT-free survival among these patients with an ALP >2.0 × ULN was 94.0% (95% CI 90.1-97.9) for those <50 >years, and 82.6% (95% CI 76.5-88.7) for those ≥50 years, which was significantly lower (p = 0.040) and similar (p = 0.736) to that of the matched population, respectively. The 10-year LT-free survival in patients ≥50 years with normal GLOBE score and normal ALP (90.8%, 95% CI 87.7-93.9) was significantly higher (p = 0.022) than the matched population. Among 1045 patients with an elevated GLOBE score, ALP was associated with LT/death only in those(aHR 1.38, 95% CI 1.06-1.81, p = 0.016).
CONCLUSION: The LT-free survival of patients with PBC with a normal GLOBE score is optimal in case of normal ALP levels, also in relation to the general population. Despite their generally favourable prognosis, an elevated ALP level may still indicate a need for add-on therapy.
de Veer, Rozanne C; Harms, Maren H; Corpechot, Christophe; Thorburn, Douglas; Invernizzi, Pietro; Janssen, Harry L A; Battezzati, Pier M; Nevens, Frederik; Lindor, Keith D; Floreani, Annarosa; Ponsioen, Cyriel Y; Mayo, Marlyn J; Parés, Albert; Mason, Andrew L; Kowdley, Kris V; Trivedi, Palak J; Hirschfield, Gideon M; Bruns, Tony; Dalekos, George N; Gatselis, Nikolaos K; Verhelst, Xavier; Lammers, Willem J; Hansen, Bettina E; van Buuren, Henk R; and van der Meer, Adriaan J, "Liver transplant-free survival according to alkaline phosphatase and GLOBE score in patients with primary biliary cholangitis treated with ursodeoxycholic acid." (2022). Articles, Abstracts, and Reports. 6540.