Evidence map›Paper›PMID 39380718›Full record

ArticleJHEP reports : innovation in hepatology2024

Loss of biochemical response at any time worsens outcomes in UDCA-treated patients with primary biliary cholangitis.

Surain B Roberts, Woo Jin Choi, Lawrence Worobetz, Catherine Vincent, Jennifer A Flemming, Angela Cheung, Karim Qumosani, Mark Swain, Dusanka Grbic, Hin Hin Ko and 36 more

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 13 papers.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed.

  1. Trial
  2. Article
  3. A Review of Therapies for Primary Biliary Cholangitis.Gastroenterology & hepatology · 2026
    Article
  4. Article
  5. Article
  6. Review
  7. Article
  8. Article
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  10. Article
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  13. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

46 authors.

Surain B RobertsToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Woo Jin ChoiInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Lawrence WorobetzDepartment of Medicine, University of Saskatchewan, Saskatoon, Canada.
Catherine VincentDépartement de Médecine, Université de Montréal, Montréal, Canada.
Jennifer A FlemmingDepartment of Medicine, Queen's University, Kingston, Canada.
Angela CheungDepartment of Medicine, University of Ottawa, Ottawa, Canada.
Karim QumosaniDepartment of Medicine, Western University, London, Canada.
Mark SwainDepartment of Medicine, University of Calgary, Calgary, Canada.
Dusanka GrbicDépartment de Médecine, Université de Sherbrooke, Sherbrooke, Canada.
Hin Hin KoDepartment of Medicine, University of British Columbia, Vancouver, Canada.
Kevork M PeltekianDepartment of Medicine, Dalhousie University, Halifax, Canada.
Lusine AbrahamyanInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Monika SainiToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Kattleya TironaToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Bishoi AzizDepartment of Medicine, University of Alberta, Edmonton, Canada.
Ellina LytvyakDepartment of Medicine, University of Alberta, Edmonton, Canada.
Pietro InvernizziEuropean Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Cyriel Y PonsioenFaculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands.
Tony BrunsDepartment of Gastroenterology and Hepatology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany.
Nora CazzagonUniversity of Padova, Padova, Italy.
Keith LindorMayo Clinic, Scottsdale, Arizona, USA.
George N DalekosEuropean Reference Network on Hepatological Diseases, Barcelona, Spain.
Nikolaos K GatselisDepartment of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
Xavier VerhelstDepartment of Hepatology, Ghent University Hospital, Ghent, Belgium.
Annarosa FloreaniUniversity of Padova, Padova, Italy.
Christophe CorpechotReference center for inflammatory biliary diseases and autoimmune hepatitis, French network for rare liver diseases FILFOIE, European reference network RARE-LIVER, Saint-Antoine University Hospital, APHP & Sorbonne University, Paris, France.
Marlyn J MayoDepartment of Medicine, Division of Digestive and Liver Disease, University of Texas, Southwestern Medical Center, Dallas, Texas, USA.
Cynthia LevySchiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, FL, USA.
Maria-Carlota LondoñoLiver Unit, Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-Institut d'Investigació Pi i Sunyer (FRCB-IDIBAPS), CIBEREHD, European Reference Network on Hepatological Rare Diseases (ERN-Liver), University of Barcelona, Barcelona, Spain.
Pier M BattezzatiUniversità degli Studi di Milano, Milan, Italy.
Albert ParesDepartment of Medicine, Liver Unit, Hospital Clínic, University of Barcelona, The August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Barcelona, Spain; European Reference Network on Hepatological Diseases, Barcelona, Spain.
Frederik NevensUniversity Hospital Katholieke Universiteit Leuven, Leuven, Belgium.
Adriaan van der MeerDepartment of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
Kris V KowdleyLiver Institute Northwest, Seattle, Washington, USA.
Palak J TrivediLiver Unit, University Hospitals Birmingham National Health Service Foundation Trust Queen Elizabeth, Birmingham, UK.
Ana LleoDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Douglas ThorburnRoyal Free London National Health Service Foundation Trust, London, United Kingdom.
Marco CarboneEuropean Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Nazia SelznerToronto General Hospital Research Institute, University Health Network, Toronto, Canada.
Aliya F GulamhuseinToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Harry LA JanssenToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Aldo J Montano-LozaDepartment of Medicine, University of Alberta, Edmonton, Canada.
Andrew L MasonDepartment of Medicine, University of Alberta, Edmonton, Canada.
Gideon M HirschfieldToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Bettina E HansenToronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Canada.
Canadian Network for Autoimmune Liver disease (CaNAL)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background & Aims: Biochemical response to ursodeoxycholic acid (UDCA) therapy is associated with good prognosis in people living with primary biliary cholangitis (PBC). Biochemical response is typically assessed early in disease and it is not known what proportion of patients lose previously attained biochemical response, nor whether this impacts long-term liver transplant (LT)-free survival. Methods: We identified all UDCA-treated patients with PBC from the Canadian Network for Autoimmune Liver disease with biochemical measurements at 1 year, and evaluated their liver biochemistry over time. Inadequate biochemical response was defined as serum alkaline phosphatase ≥1.67x the upper limit of normal or abnormal serum total bilirubin at 1 year of UDCA therapy and all time points thereafter. Multistate Markov models were used to estimate transition rates between biochemical response states and from each state to LT or death. Results were validated in an external cohort (GLOBAL PBC registry). Results: A total of 823 patients from eight centers were included. Mean age at diagnosis was 53 years, 91% were female, 33% had inadequate biochemical response to UDCA at 1 year (n = 269). Patients who retained initial adequate response had lower rates of LT or death compared to patients who subsequently lost response (relative rate 0.102, 95% CI 0.047-0.223). Patients who regained adequate response had lower rates than patients who did not (0.016, 95% CI 0.001-0.568), and patients who lost response once more (0.010, 95% CI 0.001-0.340). Patients who regained adequate response for a third time also had lower rates than patients who did not (0.151, 95% CI 0.040-0.566). Analyses in the GLOBAL PBC registry (n = 2,237) validated these results. Conclusion: Loss of biochemical response at any time is associated with heightened risks of LT or death in people living with PBC. Achievement of biochemical response is an important goal throughout follow-up, regardless of biochemical response profile early in therapy. Impact and implications: Early biochemical response to ursodeoxycholic acid is associated with good prognosis in patients with primary biliary cholangitis (PBC). Our work demonstrates that patients with PBC transition between biochemical response states over time, and that these transitions correspond with changes in risk of liver transplantation or death. Clinicians should re-evaluate risk and optimize treatment decisions for patients with PBC throughout follow-up, regardless of early biochemical response to therapy.

Indexed as

alkaline phosphataseliver transplantationprognosticationtotal bilirubinUDCA

Identifiers

PMID39380718
PMCPMC11460452

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.