EFFECT OF URSODEOXYCHOLIC ACID ON LIVER AND BILE-DUCT DISEASE IN PRIMARY SCLEROSING CHOLANGITIS - A 3-YEAR PILOT-STUDY WITH A PLACEBO-CONTROLLED STUDY PERIOD

Primary sclerosing cholangitis is a cholestatic disease of the liver characterized by progressive fibrotic inflammation and obliteration of the extra- and/or intrahepatic bile ducts. There is no effective therapy. We, therefore, studied the safety and efficacy of ursodeoxycholic acid in patients with primary sclerosing cholangitis with or without additional ulcerative colitis. In a 1-year ursodeoxycholic acid treatment period, which preceded the controlled study period, ursodeoxycholic acid was well tolerated in 22 of 24 patients with ulcerative colitis and in all three patients without ulcerative colitis. In two patients with ulcerative colitis the dose of 750 mg ursodeoxycholic acid/day led to diarrhea, but following reduction of the dose to 500 and 250 mg/day ursodeoxycholic acid was well tolerated. After 1 year of ursodeoxycholic acid treatment, 20 patients were randomly assigned to receive either ursodeoxycholic acid 750 mg/day or placebo. All of them finished a double-blind, placebo-controlled study period. During ursodeoxycholic acid treatment, the liver enzymes improved markedly. The difference in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gamma-glutamyltransferase between the placebo and ursodeoxycholic acid group was significant (p<0.05). Following ursodeoxycholic acid treatment, pruritus and fatigue improved in half of the patients but the difference between the placebo and ursodeoxycholic acid group was not significant. According to the ethical guidelines, after 3 months of placebo treatment, the controlled study had to be discontinued because of a more than twofold increase of serum transaminases in 8/10 patients on placebo. After the end of the controlled study, all patients were continuously treated with ursodeoxycholic acid for up to 4 years. In yearly retrograde cholangiographies of all patients, 1-3 years after entry into the study, progressive obliteration of bile ducts was observed in only one patient. Repeated liver biopsies were performed in ten patients after 1-3 years and showed a significant decrease in cellular infiltrates in the portal triads. Other changes were not significant. Histologic progression with a change in the stage of disease was observed in 1/10 patients and improvement was also found in 1/10 patients. In conclusion, this study shows that treatment with ursodeoxycholic acid is promising in patients with primary sclerosing cholangitis, and deserves further evaluation. (C) Journal of Hepatology.