P014 Treatment of primary biliary cholangitis (PBC): retrospective review of current therapies in a district general hospital

Abstract

<h3>Introduction</h3> We retrospectively reviewed current therapies of patients with Primary Biliary Cholangitis (PBC) at Mid Yorkshire Hospitals NHS Trust (MYHT). MYHT provides hospital services to a population of 530,000. <h3>Methods</h3> We undertook a retrospective review of 542 patient records and clinic letters. Information was obtained from electronic patient records and Sunquest ICE system. We included patients who were under outpatient review in both the Hepatology and Gastroenterology services; over a 3 year period from December 2017 to December 2020. <h3>Results</h3> 87% (n= 34) of the patient were on ursodeoxycholic acid (UDCA) therapy. Among the patients who were not on UDCA therapy, 75% (n=3) was due to their liver function test being normal and therefore they were undergoing annual monitoring and 25% (n=1) were due to medication side effects (e.g. diarrhoea). Of the patients on UDCA therapy, 56% (n=19) were on a therapeutic dose (13–15mg/kg/day). 79% (n=27) had achieved a good clinical response; biochemical normalisation in liver function tests (LFTs) with UDCA therapy with the remainder having a suboptimal biochemical response. No patient had been started on Obeticholic acid (OCA); however, 50% (n=4) of patients who have failed or intolerant to UDCA therapy were being considered for OCA therapy. Our audit showed that all patients with diagnosed PBC and abnormal LFTs had been offered and started on UDCA therapy. No patients were on fibrate therapy. <h3>Discussions</h3> The standard recommended by the British Society of Gastroenterologists (BSG) is that 90% of patients receive a therapeutic dose of UDCA and documented if tolerant. Therefore, there is still room for improvement in our current practice. It is also essential to ensure diagnosed patients be started on UDCA therapy earlier and to be referred early for OCA therapy if they fail UDCA therapy. Bezafibrate or fibrate therapy should be considered as add-on therapy for patients with incomplete response or intolerance to UDCA therapy.^{1 2} <h3>References</h3> Corpechot C. The role of fibrates in primary biliary cholangitis. <i>Curr Hepatology Rep</i> 2019;<b>18</b>:107–114. https://doi.org/10.1007/s11901–019–00455–3 Corpechot C, Chazouilleres O, Rousseau A, Le Gruyer A, Habersetzer F, Mathurin P, <i>et al</i>. A placebo-controlled trial of bezafibrate in primary biliary cholangitis. <i>N Engl J Med</i> 2018;<b>378</b>:2171–81.