DOES CHOLESTYRAMINE REDUCE THE EFFICACY OF URSODEOXYCHOLIC ACID IN PRIMARY BILIARY-CIRRHOSIS

Ursodeoxycholic acid (UDCA) has been accepted for its efficacy in the treatment of primary biliary cirrhosis. It is not clear whether such b enefit is compromised in patients who use cholestyramine for pruritus. Aims and methods: To study serum bile acid levels, liver function tes ts, and the degree of pruritus in eight patients with primary biliary cirrhosis with histological stages 1-111. The study was divided into f our consecutive phases each lasting 2 weeks: (1) cholestyramine alone; (2) wash-out period; (3) UDCA alone, and (4) both agents taken 5 h ap art. Results: UDCA with or without cholestyramine significantly reduce d alkaline phosphatase and gamma-glutamyl transpeptidase activities. T he median visual analogue score of pruritus rose from 1 6 mm at the en d of cholestyramine alone to 31 mm in the wash-out period, 25 mm on UD CA alone, and 24 mm on combined treatment. The median serum level of g lycoursodeoxycholic acid was 22 mumol/l during UDCA therapy compared w ith 6 mumol/l during cholestyramine therapy (P = 0.02), 7 mumol/l duri ng the washout phase (P = 0.02), and 19 mumol/l during combined treatm ent (P = 0.04). The increase in the levels and proportions of UDCA con jugates was accompanied by a relative fall in the proportions of the p rimary bile acids when UDCA was taken with or without cholestyramine. Conclusion: The beneficial activities of UDCA (improving liver functio n tests, reducing pruritus, and increasing UDCA conjugates) could stil l be preserved in primary biliary cirrhosis patients who use cholestyr amine, at least in the short-term when the two agents are taken at lea st 5 h apart.