Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena
Background: Mildly elevated levels of transaminase and/or immunoglobulin G (IgG) are common in patients with primary biliary cholangitis (PBC). It is still unclear whether adding immunosuppressive therapy to ursodeoxycholic acid (UDCA) benefits those patients who are not fulfilling the diagnostic cr...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2024-01-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848231224840 |
| _version_ | 1827375400405172224 |
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| author | Mengqi Li Sha Chen Shuxiang Li Tingting Lv Buer Li Shan Shan Min Li Na Zeng Qianyi Wang Yuanyuan Kong Hong Ma Xinyan Zhao Xiaojuan Ou Hong You Weijia Duan Jidong Jia |
| author_facet | Mengqi Li Sha Chen Shuxiang Li Tingting Lv Buer Li Shan Shan Min Li Na Zeng Qianyi Wang Yuanyuan Kong Hong Ma Xinyan Zhao Xiaojuan Ou Hong You Weijia Duan Jidong Jia |
| author_sort | Mengqi Li |
| collection | DOAJ |
| description | Background: Mildly elevated levels of transaminase and/or immunoglobulin G (IgG) are common in patients with primary biliary cholangitis (PBC). It is still unclear whether adding immunosuppressive therapy to ursodeoxycholic acid (UDCA) benefits those patients who are not fulfilling the diagnostic criteria of PBC with autoimmune hepatitis (AIH) features. Objectives: To assess the efficacy of adding immunosuppressive therapy to UDCA for patients with PBC and autoimmune phenomena but not fulfilling the diagnostic criteria of PBC with AIH features. Design: This is a retrospective–prospective cohort study in a tertiary medical center. Methods: Patients with PBC and autoimmune phenomena were defined by the elevation of IgG and/or transaminase but did not fulfill the diagnostic criteria of PBC with AIH features. We grouped these patients based on with and without add-on immunosuppressive therapy and balanced their baseline characteristics using inverse probability treatment weighting (IPTW). Results: A total of 652 patients with PBC and autoimmune phenomena were included, with a median follow-up of 4.08 years. After IPTW, the pseudo sample size in the add-on therapy and monotherapy groups was 558 and 655, respectively. After 1 year of observation, patients in the add-on therapy group had a higher biochemical response rate (normalization of transaminase and IgG levels) (49% versus 17%, p < 0.001). Furthermore, add-on therapy improved the transplant-free survival in the subgroup of patients with PBC and transaminase ⩾3 × upper limit of normal (ULN) or IgG ⩾1.3 × ULN ( p = 0.033). Conclusion: Add-on immunosuppressive therapy may improve the normalization rates of transaminase and IgG levels in all patients with PBC and mildly elevated transaminase and IgG levels and the long-term outcomes in the subgroup of the patients with transaminase ⩾3 × ULN or IgG ⩾1.3 × ULN. |
| first_indexed | 2024-03-08T11:50:27Z |
| format | Article |
| id | doaj.art-78df97869b504d02adc5d28f6edc7953 |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-03-08T11:50:27Z |
| publishDate | 2024-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-78df97869b504d02adc5d28f6edc79532024-01-24T13:03:45ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482024-01-011710.1177/17562848231224840Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomenaMengqi LiSha ChenShuxiang LiTingting LvBuer LiShan ShanMin LiNa ZengQianyi WangYuanyuan KongHong MaXinyan ZhaoXiaojuan OuHong YouWeijia DuanJidong JiaBackground: Mildly elevated levels of transaminase and/or immunoglobulin G (IgG) are common in patients with primary biliary cholangitis (PBC). It is still unclear whether adding immunosuppressive therapy to ursodeoxycholic acid (UDCA) benefits those patients who are not fulfilling the diagnostic criteria of PBC with autoimmune hepatitis (AIH) features. Objectives: To assess the efficacy of adding immunosuppressive therapy to UDCA for patients with PBC and autoimmune phenomena but not fulfilling the diagnostic criteria of PBC with AIH features. Design: This is a retrospective–prospective cohort study in a tertiary medical center. Methods: Patients with PBC and autoimmune phenomena were defined by the elevation of IgG and/or transaminase but did not fulfill the diagnostic criteria of PBC with AIH features. We grouped these patients based on with and without add-on immunosuppressive therapy and balanced their baseline characteristics using inverse probability treatment weighting (IPTW). Results: A total of 652 patients with PBC and autoimmune phenomena were included, with a median follow-up of 4.08 years. After IPTW, the pseudo sample size in the add-on therapy and monotherapy groups was 558 and 655, respectively. After 1 year of observation, patients in the add-on therapy group had a higher biochemical response rate (normalization of transaminase and IgG levels) (49% versus 17%, p < 0.001). Furthermore, add-on therapy improved the transplant-free survival in the subgroup of patients with PBC and transaminase ⩾3 × upper limit of normal (ULN) or IgG ⩾1.3 × ULN ( p = 0.033). Conclusion: Add-on immunosuppressive therapy may improve the normalization rates of transaminase and IgG levels in all patients with PBC and mildly elevated transaminase and IgG levels and the long-term outcomes in the subgroup of the patients with transaminase ⩾3 × ULN or IgG ⩾1.3 × ULN.https://doi.org/10.1177/17562848231224840 |
| spellingShingle | Mengqi Li Sha Chen Shuxiang Li Tingting Lv Buer Li Shan Shan Min Li Na Zeng Qianyi Wang Yuanyuan Kong Hong Ma Xinyan Zhao Xiaojuan Ou Hong You Weijia Duan Jidong Jia Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena Therapeutic Advances in Gastroenterology |
| title | Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| title_full | Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| title_fullStr | Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| title_full_unstemmed | Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| title_short | Add-on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| title_sort | add on immunosuppressive therapy may benefit selected patients with primary biliary cholangitis and autoimmune phenomena |
| url | https://doi.org/10.1177/17562848231224840 |
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