A RANDOMIZED TRIAL IN PRIMARY BILIARY-CIRRHOSIS COMPARING URSODEOXYCHOLIC ACID IN DAILY DOSES OF EITHER 10 MG KG OR 20 MG/KG/

Background: Ursodeoxycholic acid (UDCA) prolongs transplantation-free survival in primary biliary cirrhosis (PBC). However, the optimal ther apeutic dose has not been established. Aim: To compare the effects of UDCA administered in daily doses of 10 vs. 20 mg/kg on symptoms, liver biochemistry and biliary UDCA enrichment. Methods: A 6-month multicen tre randomized open controlled trial was conducted to assess the effec ts of an increase in the dose of UDCA to 20 mg/kg/day vs. continuation of 10 mg/kg/day for patients who had not achieved biochemical normali zation during treatment for at least 6 months with the 10 mg/kg dose. Clinical and laboratory evaluations were performed at entry and at 3-m onth intervals. The percentage UDCA in duodenal bile was assessed at e ntry and at 6 months.Results: Sixty-one patients were enrolled. No sid e-effects of UDCA were observed. Within the 20 mg/kg/day group signifi cant decreases were found for alkaline phosphatase (- 8%; P = 0.003), aspartate aminotransferase (- 11%; P = 0.01), alanine aminotransferase (- 17%; P < 0.001), gamma-glutamyl transferase (- 34%; P < 0.001), im munoglobulin M (- 11%; P = 0.002) and cholesterol (- 8.1%; P < 0.001). In the 10 mg/kg group none of these parameters differed significantly from baseline. No significant differences between dose groups for sym ptom scores or serum bilirubin were found. Biliary enrichment with UDC A increased from 37% to 46% in the 20 mg/kg group (P = 0.02) while rem aining stable in the 10 mg/kg group. Conclusions: Liver biochemistry i mproved in PBC patients receiving UDCA 20 mg/kg/day compared to a dose of 10 mg/kg/day. Both doses were equally well tolerated. These result s indicate that UDCA 10 mg/kg/day is a suboptimal dose for treating PB C.