Long-term ursodeoxycholic acid delays histological progression in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease frequently leading to development of cirrhosis and its complications. Ursod eoxycholic acid (UDCA) is a beneficial medical therapy for patients with PB C. Improvement in some histological features, but not in histological stage , has been reported after 2 years of UDCA therapy, Thus, longer follow-up m ay be necessary to determine whether UDCA has a favorable effect on histolo gical stage of disease and progression to cirrhosis. Our aim was to determi ne the long-term effects of UDCA therapy on histological stage and progress ion to cirrhosis in patients with PBC. Sixteen unselected patients with non cirrhotic PBC who had been on long-term UDCA therapy (13-15 mg/kg/d) for 6. 6 +/- 0.4 years (range, 5-9 years) were identified and their histological f inding during treatment compared with that of 51 noncirrhotic patients with PBC who had received ineffective therapy (D-penicillamine [DPCA] or placeb o) for 5.6 +/- 0.07 years (range, 5-8 years). Histological stage was determ ined using the Ludwig classification, The rate of progression to cirrhosis (stage 4) was significantly less in the UDCA group than in the control grou p (13% vs. 49%; P = .009). Although the overall rate of progression of hist ological stage was less in the UDCA group than in the control group (50% vs . 71%), this difference was not significant (P = .1). A marked improvement in liver biochemistries and Mayo risk score was noted in all patients durin g UDCA therapy; however, this improvement was not significantly different b etween patients who progressed and those who did not. In conclusion, long-t erm UDCA therapy appeared to delay the development of cirrhosis in PBC.