Evidence map›Paper›PMID 41021281›Full record

ArticleHepatology communications2025

High biochemical remission rates in patients with primary biliary cholangitis treated with "triple" anticholestatic therapy.

Guilherme G L Cançado, Bo Chen, Madeline Cameron, Inbal Houri, Kristel K Leung, Aliya F Gulamhusein, Bettina Hansen, Gideon M Hirschfield

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Hepatology communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing 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

3 citing papers in PubMed.

  1. Treatment Goals for Primary Biliary Cholangitis, an Australian Perspective.Journal of gastroenterology and hepatology · 2026
    Review
  2. Machine Learning Predicts Treatment Response and Prognostic Pathways From Whole-Blood Transcriptome in Primary Biliary Cholangitis.Liver international : official journal of the International Association for the Study of the Liver · 2026
    Article
  3. Dysbiosis in the Gut-Liver Axis Is Associated With Low Bone Mass During Murine Cholestasis.FASEB journal : official publication of the Federation of American Societies for Experimental Biology · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Guilherme G L CançadoThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0002-7824-2152
Bo ChenThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Madeline CameronThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0009-0000-1183-5386
Inbal HouriThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0002-6397-6604
Kristel K LeungThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0002-1161-4118
Aliya F GulamhuseinThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0003-4648-4736
Bettina HansenThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0001-8307-3341
Gideon M HirschfieldThe Autoimmune and Rare Liver Disease Programme, Division of Gastroenterology and Hepatology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.ORCID 0000-0002-6736-2255

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment goals in primary biliary cholangitis (PBC) are increasingly aspirational, aiming for normal serum liver tests. One of the add-on therapies to ursodeoxycholic acid (UDCA) is with the approved farnesoid X receptor (FXR) agonist obeticholic acid (OCA), alongside off-label use of fibrates (peroxisome proliferator-activated receptor [PPARs]). We report our experience of synergistic FXR-PPAR-UDCA combination therapy in PBC.

methodsA review of patients with PBC seen between July 2022 and July 2023 was performed across the autoimmune liver disease programme at the Toronto Centre for Liver Disease. Univariate and multivariate analyses were performed.

resultsFour hundred seventy patients with PBC were seen, of which 71% were treated with UDCA only, 7% UDCA-OCA, 11.3% UDCA-fibrates, and 10.6% UDCA-OCA-fibrates. Among 50 patients on triple therapy, 82% had OCA as the first add-on therapy. Most patients (92%) received bezafibrate, while 8% had fenofibrate. Forty-eight patients were included in the final analysis. The mean follow-up time after triple therapy was 17.4 months. Triple therapy demonstrated median ALP reductions after 6 months of 33.3% (95% CI: 27.9%-37.6%) and 39.1% (95% CI: 30.7%-46.2%) at the last follow up; 30.2% of the patients had a normal serum ALP at 6 months, while 11.9% had normal ALP, AST, ALT, and bilirubin. Subgroup analysis of 28 patients followed for at least 12 months showed a 44.7% (95% CI: 33.3%-50.9%) median reduction in ALP. Liver stiffness remained relatively stable throughout the follow-up. Out of 34 patients with self-reported pruritus before triple therapy, 64.7% reported improvement, 11.8% worsened, and 23.5% had no change in itching intensity. On multivariable analysis, only older age at diagnosis (OR=1.12; 95% CI: 1.02-1.22) positively impacted ALP normalization.

conclusionsOur data confirm that FXR-PPAR-UDCA triple therapy significantly improves ALP with normalization for 30% of patients with PBC at 6 months.

Indexed as

Chenodeoxycholic AcidCholagogues and CholereticsFibric AcidsLiver Cirrhosis, BiliaryUrsodeoxycholic AcidAdultAgedBezafibrateDrug Therapy, CombinationFemaleFenofibrateHumansLiver Function TestsMaleMiddle AgedPeroxisome Proliferator-Activated ReceptorsBezafibrateChenodeoxycholic AcidCholagogues and CholereticsFenofibrateFibric Acidsobeticholic acidPeroxisome Proliferator-Activated ReceptorsReceptor, Farnesoid X-ActivatedReceptors, Cytoplasmic and NuclearUrsodeoxycholic Acidfibratesincomplete respondersobeticholic acidtreatmentursodeoxycholic acid

Identifiers

PMID41021281
PMCPMC12483066

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LicenceCC BY-NC-ND
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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.