Citations 1
Liver transplant‐free survival according to alkaline phosphatase and GLOBE score in patients with primary biliary cholangitis treated with ursodeoxycholic acid
Veer, Rozanne C. de , Harms, Maren H. , Thorburn, Douglas , Janssen, Harry L.A. , Nevens, Frederik , Lindor, Keith D. , Floreani, Annarosa , Ponsioen, Cyriel Y. , Mayo, Marlyn J. , Parés, Albert , Mason, Andrew L. , Bruns, Tony , Buuren, Henk R. van , Meer, Adriaan J. van der, Group, the Global PBC Study, van der Meer, Adriaan J , Invernizzi, Pietro , Lindor, K D , Mayo, Marlyn J , Mason, Andrew , Hirschfield, Gideon M , Bruns, Tony , Verhelst, Xavier , Corpechot, Christophe , Invernizzi, Pietro , Battezzati, Pier Maria , Kowdley, Kris V. , Trivedi, Palak Jitendrakumar , Hirschfield, Gideon M. , Dalekos, George Ν. , Gatselis, Nikolaos , Verhelst, Xavier , Lammers, Willem J. , Hansen, Bettina E. , Meer, Adriaan J. van der, Group, the Global PBC Study
Alimentary Pharmacology & Therapeutics | September 23, 2022 | Volume: 56 | Issue: 9 | Pages: 1408-1418
SummaryBackgroundAfter 1 year of ursodeoxycholic acid (UDCA), patients with primary biliary cholangitis (PBC) may have a normal GLOBE score despite high alkaline phosphatase (ALP) levels.AimTo assess the association between ALP and liver transplantation (LT)‐free survival according to the GLOBE scoreMethodsAmong patients with a normal or elevated GLOBE score in the Global PBC cohort, the association between ALP after 1 year of UDCA and the risk of LT/death was assessed. The LT‐free survival was compared with that of a matched general population.ResultsAfter 1 year of UDCA, ALP was associated with the risk of LT/death (aHR 1.31, 95% CI 1.003–1.72, p = 0.048) among 2729 patients with a normal GLOBE score. The 10‐year LT‐free survival among these patients with an ALP >2.0 × ULN was 94.0% (95% CI 90.1–97.9) for those <50 years, and 82.6% (95% CI 76.5–88.7) for those ≥50 years, which was significantly lower (p = 0.040) and similar (p = 0.736) to that of the matched population, respectively. The 10‐year LT‐free survival in patients ≥50 years with normal GLOBE score and normal ALP (90.8%, 95% CI 87.7–93.9) was significantly higher (p = 0.022) than the matched population. Among 1045 patients with an elevated GLOBE score, ALP was associated with LT/death only in those <50 years (aHR 1.38, 95% CI 1.06–1.81, p = 0.016).ConclusionThe LT‐free survival of patients with PBC with a normal GLOBE score is optimal in case of normal ALP levels, also in relation to the general population. Despite their generally favourable prognosis, an elevated ALP level may still indicate a need for add‐on therapy.