Long-Term Obeticholic Acid Therapy Improves Histological Endpoints in Patients With Primary Biliary Cholangitis

Bowlus CL, Pockros PJ, Kremer A, Parés A, Forman LM, Drenth JP, Ryder SD, Terracciano L, Jin Y, Liberman A, Pencek R, Iloeje U, MacConell L, Bedossa P (2020)

Publication Type: Journal article

Publication year: 2020

Journal

Clinical Gastroenterology and Hepatology WB Saunders

DOI: 10.1016/j.cgh.2019.09.050

Abstract

Background & Aims: Primary biliary cholangitis (PBC) is an autoimmune disease characterized by bile duct destruction that can progress to cirrhosis. A liver biopsy substudy was conducted in the PBC obeticholic acid (OCA) International Study of Efficacy (POISE) to determine the long-term effects of OCA on liver damage and fibrosis in patients with PBC. POISE is a phase 3, double-blind, placebo-controlled, randomized trial with a 5-year open-label extension that evaluated 5 to 10 mg OCA daily in patients who were intolerant or unresponsive to ursodeoxycholic acid. Methods: Liver biopsy specimens were collected from 17 patients at time of enrollment in the double-blind phase and after 3 years of OCA treatment. Histologic evaluations were performed by 2 pathologists in a blinded, randomized fashion to determine the effects of OCA on fibrosis and other histologic parameters. Collagen morphometry assessments were performed by automated second harmonic generation and 2-photon excitation microscopy to observe quantitative measures of fibrosis. Results: From the time of enrollment until 3 years of treatment, most patients had improvements or stabilization in fibrosis (71%), bile duct loss (76%), ductopenia (82%), ductular reaction (82%), interface hepatitis (100%), and lobular hepatitis (94%). Over the 3-year period, we found significant reductions in collagen area ratio (median, –2.1; first quartile, –4.6, third quartile, –0.3; P =.013), collagen fiber density (median, –0.8; first quartile, –2.5; third quartile, 0; P =.021), collagen reticulation index (median, –0.1; first quartile, –0.3; third quartile, 0; P =.008), and fibrosis composite score (median, –1.0; first quartile, –2.5; third quartile, –0.5; P =.002). Conclusions: A subanalysis of data from the POISE study showed that long-term OCA treatment in patients with PBC is associated with improvements or stabilization of disease features, including ductular injury, fibrosis, and collagen morphometry features (ClinicalTrials.gov no: NCT01473524 and EudraCT no: 2011-004728-36).

Authors with CRIS profile

Andreas Kremer Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology

Involved external institutions

University of California Davis (UCDAVIS) US United States (USA) (US) Scripps Research Institute (TSRI) US United States (USA) (US) Universitat de Barcelona (UB) / University of Barcelona ES Spain (ES) Nottingham University Hospitals GB United Kingdom (GB) Université de Paris FR France (FR) Intercept Pharmaceuticals US United States (USA) (US) University of Colorado System US United States (USA) (US) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) NL Netherlands (NL) Universität Basel CH Switzerland (CH)

How to cite

APA:

Bowlus, C.L., Pockros, P.J., Kremer, A., Parés, A., Forman, L.M., Drenth, J.P.,... Bedossa, P. (2020). Long-Term Obeticholic Acid Therapy Improves Histological Endpoints in Patients With Primary Biliary Cholangitis. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2019.09.050

MLA:

Bowlus, Christopher L., et al. "Long-Term Obeticholic Acid Therapy Improves Histological Endpoints in Patients With Primary Biliary Cholangitis." Clinical Gastroenterology and Hepatology (2020).

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