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Abstract Details
Effects of Age and Sex of Response to Ursodeoxycholic Acid and Transplant-free Survival in Patients With Primary Biliary Cholangitis
Gastroenterol Hepatol. 2019 Sep;17(10):2076-2084.e2. doi: 10.1016/j.cgh.2018.12.028.Epub 2019 Jan 4.
Angela C Cheung1, Willem J Lammers2, Carla F Murillo Perez3, Henk R van Buuren2, Aliya Gulamhusein3, Palak J Trivedi4, Konstantinos N Lazaridis1, Cyriel Y Ponsioen5, Annarosa Floreani6, Gideon M Hirschfield3, Christophe Corpechot7, Marlyn J Mayo8, Pietro Invernizzi9, Pier Maria Battezzati10, Albert Parés11, Frederik Nevens12, Douglas Thorburn13, Andrew L Mason14, Marco Carbone9, Kris V Kowdley15, Tony Bruns16, George N Dalekos17, Nikolaos K Gatselis17, Xavier Verhelst18, Keith D Lindor19, Ana Lleo9, Raoul Poupon7, Harry L A Janssen3, Bettina E Hansen20, Global PBC Study Group
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Abstract
Background & aims: Primary biliary cholangitis (PBC) predominantly affects middle-aged women; there are few data on disease phenotypes and outcomes of PBC in men and younger patients. We investigated whether differences in sex and/or age at the start of ursodeoxycholic acid (UDCA) treatment are associated with response to therapy, based on biochemical markers, or differences in transplant-free survival.
Methods: We performed a longitudinal retrospective study of 4355 adults in the Global PBC Study cohort, collected from 17 centers across Europe and North America. Patients received a diagnosis of PBC from 1961 through 2014. We evaluated the effects of sex and age on response to UDCA treatment (based on GLOBE score) and transplant-free survival using logistic regression and Cox regression analyses, respectively.
Results: Male patients were older at the start of treatment (58.3±12.1 years vs 54.3±11.6 years for women; P<.0001) and had higher levels of bilirubin and lower circulating platelet counts (P<.0001). Younger patients (45 years or younger) had increased serum levels of transaminases than older patients (older than 45 years). Patients older than 45 years at time of treatment initiation had increased odds of a biochemical response to UDCA therapy, based on GLOBE score, compared to younger patients. The greatest odds of response to UDCA were observed in patients older than 65 years (odds ratio compared to younger patients 45 years or younger, 5.48; 95% CI, 3.92-7.67; P<.0001). Risk of liver transplant or death (compared to a general population matched for age, sex, and birth year) decreased significantly with advancing age: hazard ratio for patients 35 years or younger, 14.59 (95% CI, 9.66-22.02) vs hazard ratio for patients older than 65 years, 1.39 (95% CI, 1.23-1.57) (P<.0001). On multivariable analysis, sex was not independently associated with response or transplant-free survival.
Conclusion: In longitudinal analysis of 4355 adults in the Global PBC Study, we associated patient age, but not sex, with response to UDCA treatment and transplant-free survival. Younger age at time of treatment initiation is associated with increased risk of treatment failure, liver transplant, and death.