P187 Are we identifying and treating PBC appropriately? 5 year experience in a single centre

Abstract

Introduction National guidelines on the management of primary biliary cholangitis (PBC) were published by the BSG and UKPBC in 2018.1 We examined a database of all patients who had undergone anti-mitochondrial antibody (AMA) testing over a five year period in a single centre (a district general hospital serving a population of 220,000), to examine adequacy of PBC diagnosis, ursodeoxycholic acid (UDCA) dosing, biochemical response, and referral for second line therapy in cases of UDCA intolerance or failure, using the thresholds and recommendations set out in the BSG UKPBC 2018 guidelines. Methods A laboratory database search was carried out to capture all AMA test results from 01 April 2014–31 March 2019. Laboratory records for all patients with a positive AMA at any titre were cross referenced, and a registry created of all patients with positive AMA and biochemical evidence of cholestasis (elevated alkaline phosphatase (ALP) above the upper limit of normal), or a pre-existing diagnosis of PBC regardless of ALP. Medical records were examined of all patients on this registry to establish history of diagnosis of PBC, treatment history, dosing of UDCA in mg/kg, adequacy of response to UDCA, and referral for second line therapy with obeticholic acid (OCA) where relevant. Results 20783 AMA tests were carried out with positive results for AMA at any titre recorded in 155 individual patients; 45 had evidence of cholestasis at the time of index AMA testing, 23 of whom had been diagnosed with PBC by the end of the study period. A further 6 AMA positive patients had an existing diagnosis of PBC with normalised ALP on treatment, giving a total PBC population of 29 patients. 25/29 (86%) of PBC patients were treated with UDCA, which was adequately dosed in 23/25 (92%). 15/19 (79%) of patients who had completed at least one year of adequately dosed UDCA responded adequately (ALP Conclusions AMA testing was commonly carried out in a district general hospital setting, but the cohort of PBC patients identified was small. In those diagnosed with PBC, UDCA dosing was done well overall, but more than 20% of patients did not respond adequately or could not tolerate UDCA. Even in a small PBC cohort such as this, there are likely to be patients who may benefit from second line therapy with OCA. Such cases can be identified through simple audit of UDCA dosing and biochemical response. Reference Hirschfield G et al. The British Society of Gastroenterology/UKPBC primary biliary cholangitis treatment and management guidelines. Gut 2018;0:1–27