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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2019/02  
 
  2019 Feb.  
  doi: 10.1002/hep.30552.  
 
  Bezafibrate improves GLOBE and UK-PBC scores and long-term outcomes in patients with primary biliary cholangitis.  
 
  Honda A, Tanaka A, Kaneko T, Komori A, Abe M, Inao M, Namisaki T, Hashimoto N, Kawata K, Takahashi A, Ninomiya M, Kang JH, Arakawa M, Yamagiwa S, Joshita S, Umemura T, Sato K, Kaneko A, Kikuchi K, Itakura J, Nomura T, Kakisaka K, Fujii H, Kawada N, Takikawa Y, Masaki T, Ohira H, Mochida S, Yoshiji H, Iimuro S, Matsuzaki Y, Takikawa H; Japan PBC Study Group (JPBCSG).  
  https://www.ncbi.nlm.nih.gov/pubmed/30737815  
 
 

Abstract

In Japan, bezafibrate (BF) is a second-line agent for primary biliary cholangitis (PBC) that is refractory to ursodeoxycholic acid (UDCA) treatment. From a retrospective cohort (n=873) from the Japan PBC Study Group, we enrolled 118 patients who had received UDCA monotherapy for ≥1 year followed by combination therapy with UDCA+BF for ≥1 year. GLOBE and UK-PBC scores after UDCA monotherapy (that is, immediately before UDCA+BF combination therapy) were compared with those after 1 year of UDCA+BF combination therapy. The real outcomes of enrolled patients estimated by Kaplan-Meier analysis were compared with the predicted outcomes calculated using GLOBE and UK-PBC scores. In addition, the hazard ratio of BF treatment was calculated using propensity score analysis. The mean GLOBE score before the combination therapy was 0.504 ± 0.080, which improved significantly to 0.115 ± 0.085 (p<0.0001) after 1 year of combination therapy. The real liver transplant-free survival of enrolled patients was significantly better than that predicted by GLOBE score before introducing BF. Combination therapy did not significantly improve the real rates of liver transplantation or liver-related death compared with those predicted by UK-PBC risk score before introducing BF, but the predicted risk was significantly reduced by the addition of BF (p<0.0001). Cox regression analysis with inverse probability of treatment weighting showed that the addition of BF significantly reduced the hazard of liver transplant or liver-related death in patients who, after 1 year of UDCA monotherapy, had normal serum bilirubin (adjusted hazard ratio 0.09, 95% CI 0.01-0.60, p=0.013).

Conclusion: Addition of BF to UDCA monotherapy improves not only GLOBE and UK-PBC scores but also the long-term prognosis of PBC patients, especially those with early-stage PBC. This article is protected by copyright. All rights reserved.

 
 
Question posée
 
Efficacité du bézafibrate en association à l’acide ursodésoxycholique (UDCA) et impact sur le pronostic à long terme des patients ayant une cholangite biliaire primitive.
 
Question posée
 
L’association bézafibrate + UDCA améliore non seulement les scores GLOBE e UK-PBC mais aussi le pronostic à plus long terme surtout chez les patients au stade précoce.
 
Commentaires

Un autre argument pour utiliser le bézafibrate en 2ème ligne… A quand l’AMM ?

 
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