Combined analysis of the effect of treatment with ursodeoxycholic acid on histologic progression in primary biliary cirrhosis

Background/Aims: This study aimed at evaluating the effect of ursodeoxycholic acid (UDCA) treatment on histologic progression in primary biliary cirrhosis (PBC). Methods: Using combined individual histologic findings from four clinical trials, we selected the patients in whom paired liver-biopsy specimens were available with a time interval of about 36 months between biopsies. A total of 367 patients were selected (UDCA: 200 vs. placebo: 167). Results: Overall, there was no significant difference in the progression of the histologic stage between the two groups. By contrast, in the subgroup of patients with initial stages I-II (n = 177) there was a significant decrease in the histologic stage progression in the UDCA group relative to the placebo group (P < 0.03). Overall, there was a significant delay in the progression of periportal necroinflammatory lesions (P = 0.03), and an improvement in the degree of ductular proliferation (P = 0.02) in the UDCA group compared with the placebo group. There was no significant difference in the progression of other specific lesions. Conclusions: A 2-year UDCA treatment reduces periportal necroinflammation and improves ductular proliferation, and when initiated at the earlier stages I-II of the disease also delays the progression of histologic stage. These data support the early initiation of the drug to prevent these histologic features of PBC. (C) 2003 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.