Effects of Age and Sex of Response to Ursodeoxycholic Arid and Transplant-free Survival in Patients With Primary Biliary Cholangitis

被引：56

作者：

Cheung, Angela C. ^{[1
]}

Lammers, Willem J. ^{[2
]}

Perez, Carla F. Murillo ^{[3
]}

van Buuren, Henk R. ^{[2
]}

Gulamhusein, Aliya ^{[3
]}

Trivedi, Palak J. ^{[4
]}

Lazaridis, Konstantinos N. ^{[1
]}

Ponsioen, Cyriel Y. ^{[5
]}

Floreani, Annarosa ^{[6
]}

Hirschfield, Gideon M. ^{[3
]}

Corpechot, Christophe ^{[7
]}

Mayo, Marlyn J. ^{[8
]}

Invernizzi, Pietro ^{[9
,10
]}

Battezzati, Pier Maria ^{[11
]}

Pares, Albert ^{[12
]}

Nevens, Frederik ^{[13
]}

Thorburn, Douglas ^{[14
]}

Mason, Andrew L. ^{[15
]}

Carbone, Marco ^{[9
,10
]}

Kowdley, Kris V. ^{[16
]}

Bruns, Tony ^{[17
]}

Dalekos, George N. ^{[18
,19
]}

Gatselis, Nikolaos K. ^{[18
,19
]}

Verhelst, Xavier ^{[20
]}

Lindor, Keith D. ^{[21
]}

Lleo, Ana ^{[9
,10
]}

Poupon, Raoul ^{[7
]}

Janssen, Harry L. A. ^{[3
]}

Hansen, Bettina E. ^{[2
,3
,22
]}

机构：

[1] Mayo Clin, Div Gastroenterol & Hepatol, Rochester, MN USA

[2] Erasmus MC, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands

[3] Univ Hlth Network, Toronto Gen Hosp, Toronto Ctr Liver Dis, Toronto, ON, Canada

[4] Univ Birmingham, NIHR, Ctr Liver Res, Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

[5] Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[6] Univ Padua, Dept Surg Oncol & Gastroenterol, Padua, Italy

[7] Hop St Antoine, Ctr Natl Reference Malad Inflammatoires Foie & Vo, Serv Hepatol, Paris, France

[8] Univ Texas Southwestern Med Ctr Dallas, Digest & Liver Dis, Dallas, TX 75390 USA

[9] Univ Milano Bicocca, Div Gastroenterol, Milan, Italy

[10] Univ Milano Bicocca, Ctr Autoimmune Liver Dis, Dept Med & Surg, Milan, Italy

[11] Univ Milan, Dept Hlth Sci, Milan, Italy

[12] Univ Barcelona, Hosp Clin, Liver Unit, IDIBAPS,CIBERehd, Barcelona, Spain

[13] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Hepatol, Leuven, Belgium

[14] Royal Free Hosp, Sheila Sherlock Liver Ctr, London, England

[15] Univ Alberta, Div Gastroenterol & Hepatol, Edmonton, AB, Canada

[16] Swedish Med Ctr, Liver Care Network, Seattle, WA USA

[17] Friedrich Schiller Univ Jena, Jena Univ Hosp, Dept Internal Med 4, Jena, Germany

[18] Univ Thessaly, Dept Med, Larisa, Greece

[19] Univ Thessaly, Res Lab Internal Med, Larisa, Greece

[20] Ghent Univ Hosp, Dept Gastroenterol & Hepatol, Ghent, Belgium

[21] Arizona State Univ, Coll Hlth Solut, Phoenix, AZ USA

[22] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

来源：

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY | 2019年 / 17卷 / 10期

关键词：

Risk Stratification; Stratified Medicine; Cholestatic Liver Disease; Mortality; BIOCHEMICAL RESPONSE; CIRRHOSIS; ACID; EPIDEMIOLOGY; PREDICTORS; MANAGEMENT; PROGNOSIS; VARICES; SYSTEM;

D O I：

10.1016/j.cgh.2018.12.028

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND & AIMS: Primary biliary cholangitis (PBC) predominantly affects middle-aged women; there are few data on disease phenotypes and outcomes of PBC in men and younger patients. We investigated whether differences in sex and/or age at the start of ursodeoxycholic acid (UDCA) treatment are associated with response to therapy, based on biochemical markers, or differences in transplant-free survival. METHODS: We performed a longitudinal retrospective study of 4355 adults in the Global PBC Study cohort, collected from 17 centers across Europe and North America. Patients received a diagnosis of PBC from 1961 through 2014. We evaluated the effects of sex and age on response to UDCA treatment (based on GLOBE score) and transplant-free survival using logistic regression and Cox regression analyses, respectively. RESULTS: Male patients were older at the start of treatment (58.3 +/- 12.1 years vs 54.3 +/- 11.6 years for women; P<.0001) and had higher levels of bilirubin and lower circulating platelet counts (P<.0001). Younger patients (45 years or younger) had increased serum levels of transaminases than older patients (older than 45 years). Patients older than 45 years at time of treatment initiation had increased odds of a biochemical response to UDCA therapy, based on GLOBE score, compared to younger patients. The greatest odds of response to UDCA were observed in patients older than 65 years (odds ratio compared to younger patients 45 years or younger, 5.48; 95% CI, 3.92-7.67; P<.0001). Risk of liver transplant or death (compared to a general population matched for age, sex, and birth year) decreased significantly with advancing age: hazard ratio for patients 35 years or younger, 14.59 (95% CI, 9.66-22.02) vs hazard ratio for patients older than 65 years, 1.39 (95% CI, 1.23-1.57) (P<.0001). On multivariable analysis, sex was not independently associated with response or transplant-free survival. Conclusion: In longitudinal analysis of 4355 adults in the Global PBC Study, we associated patient age, but not sex, with response to UDCA treatment and transplant-free survival. Younger age at time of treatment initiation is associated with increased risk of treatment failure, liver transplant, and death.

引用

页码：2076 / +

页数：11

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