DIFFERENT RESPONSE TO URSODEOXYCHOLIC ACID (UDCA) IN PRIMARY BILIARY-CIRRHOSIS ACCORDING TO SEVERITY OF DISEASE

To evaluate the effect of ursodeoxycholic acid (UDCA) treatment accord ing to the severity of primary biliary cirrhosis, a long-term prospect ive open trial in 54 consecutive PBC patients, 19 with histological st age I-II, 24 stage III, and 11 stage IV was carried out. UDCA was admi nistered at a dosage of 250 mg twice a day. Clinical and biochemical a ssessment (AST, ALT, alkaline phosphatase, GGT, bilirubin) were done i nitially and every six months. Serum hyaluronate (HY) and type III pro collagen amino propeptide (PIIIP) were also evaluated, as they are con sidered markers of fibrosis and prognosis. All patients were followed- up for at least two rears (24-36 months); results were analyzed at 24 months after treatment. The composite pruritus score failed to show si gnificant changes during UDCA treatment, while intensity score demonst rated a significant reduction from the 6th month. Patients with histol ogical stage I-II disease had a significant decrease of liver enzymes (AST, ALT, alkaline phosphatase, GGT) after six months and maintained the levels up to 24 months. The patients with histological stage III d isease showed a significant decrease of AST, ALT, alkaline phosphatase (but not GGT) up to month 18; subsequently AST and ALT serum levels i ncreased, reaching values comparable to baseline by 24 months. In pati ents with histological stage IV disease no significant change in liver enzymes was observed during the follow-up. HY and PIIIP serum levels failed to show significant changes during UDCA treatment in the three groups of patients. In conclusion, although well tolerated in all pati ents with PBC, UDCA seems to improve itching and liver enzymes only in the pre cirrhotic stage. A long-term remission of the disease is main tained only in the early histological stages.