Fibrates for the Treatment of Primary Biliary Cholangitis Unresponsive to Ursodeoxycholic Acid: An Exploratory Study

• Autor(a) principal: Guilherme Grossi Lopes Cançado
• Data de Publicação: 2022
• Outros Autores: Luciana Costa Faria, Elze Maria Gomes de Oliveira, Vivian Rotman, Daniel Ferraz de Campos Mazo, Valéria Ferreira de Almeida e Borges, Liliana Sampaio Costa Mendes, Liana Codes, Mario Guimarães Pessoa, Izabelle Venturini Signorelli, Cynthia Levy, Cláudia Alves Couto, Paulo Lisboa Bittencourt, Laura Vilar Guedes, Michelle Harriz Braga, Débora Raquel Benedita Terrabuio, Eduardo Luiz Rachid Cançado, Maria Lucia Gomes Ferraz, Cristiane Alves Villela-Nogueira, Mateus Jorge Nardelli
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.3389/fphar.2021.818089; http://hdl.handle.net/1843/60513; https://orcid.org/0000-0003-3664-4839
• topic: Bezafibrate; Ciprofibrate; Fibrate; Primary biliary cholangitis; Treatment failure; Ursodeoxycholic acid; Falha de Tratamento; Ácidos Fíbricos; Ácido Ursodesoxicólico; Cirrose Hepática Biliar; Bezafibrato

Aim: Up to 40% of patients with primary biliary cholangitis (PBC) will have a suboptimal biochemical response to ursodeoxycholic acid (UDCA), which can be improved by the addition of fibrates. This exploratory study aims to evaluate the long-term real-life biochemical response of different fibrates, including ciprofibrate, in subjects with UDCA-unresponsive PBC. Methods: The Brazilian Cholestasis Study Group multicenter database was reviewed to assess the response rates to UDCA plus fibrates in patients with UDCA-unresponsive PBC 1 and 2 years after treatment initiation by different validated criteria. Results: In total, 27 patients (100% women, mean age 48.9 ± 9.2 years) with PBC were included. Overall response rates to fibrates by each validated criterion varied from 39 to 60% and 39–76% at 12 and 24 months after treatment combination, respectively. Combination therapy resulted in a significant decrease in ALT and ALP only after 2 years, while GGT significantly improved in the first year of treatment. Treatment response rates at 1 and 2 years appear to be comparable between ciprofibrate and bezafibrate using all available criteria. Conclusion: Our findings endorse the efficacy of fibrate add-on treatment in PBC patients with suboptimal response to UDCA. Ciprofibrate appears to be at least as effective as bezafibrate and should be assessed in large clinical trials as a possibly new, cheaper, and promising option for treatment of UDCA-unresponsive PBC patients.