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- Title
Liver transplant‐free survival according to alkaline phosphatase and GLOBE score in patients with primary biliary cholangitis treated with ursodeoxycholic acid.
- Authors
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.
- Abstract
Summary: 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 <50 years (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.
- Subjects
CHOLANGITIS; ALKALINE phosphatase; URSODEOXYCHOLIC acid; OVERALL survival; LIVER transplantation; LIVER; INTRAHEPATIC bile ducts
- Publication
Alimentary Pharmacology & Therapeutics, 2022, Vol 56, Issue 9, p1408
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.17226